Hypoglycemic sensorimotor polyneuropathy associated with insulinoma

Hypoglycemia-induced peripheral neuropathy due to insulinoma is unusual and, as far as we know, has previously been reported in only 34 patients. In this case report, we describe the clinical features, electrophysiological features, and pathological findings in a 37-year-old patient with polyneuropathy from repeated hypoglycemic episodes over a 9-year period that related to an insulinoma. The literature is discussed. The reported case is of special interest because the peripheral neuropathy led to the correct diagnosis.     

Critical illness polyneuropathy: a case report

Critical illness polyneuropathy (CIP) is defined as a common complication of critically ilness patients who were admitted to the intensive care unit due to sepsis, multiple trauma and/or multi-organ failure. We aimed to present a patient who was diagnosed as CIP. He was admitted to our outpatient clinic due to weakness and pain in his lower extremities. He had been followed in an intensive care unit due to suicid five months ago. There were symmetrically and predominantly muscle weakness, sensory impairment, absence of deep tendon reflexes in his lower extremities. Electrophysiological evaluation demonstrated motor and sensory axonal distal polyneuropathy predominantly in lower extremities. At follow up, he had high fever, and elevated acute phase responses. Therefore source of infection was investigated and was suspected to a diagnosis of infective endocarditis. He was discharged to be hospitalized in cardiology clinic. With this case, we think that physiatrists should take into consideration a diagnosis of critical illness polyneuropathy in patients with symmetric motor weakness. In CIP, muscle weakness, sensory loss, neuropathic pain, and autonomic problems lengthened the rehabilitation period. Due to a diagnosis of infective endocarditis in our case, we point out that source of infection should be carefully investigated if there is acute phase responses in CIP patients even if during rehabilitation period.     

Sensorimotor polyneuropathy with 5-aminosalicylic acid: a case report.

A 69-year-old man with ulcerative colitis (UC) developed sensorimotor polyneuropathy. First, he received salazosulphapyridine (SASP) as treatment for the UC. The symptoms of UC disappeared immediately, but he developed skin eruptions and dysesthesia in his lower limbs. When SASP was changed to 5-aminosalicylic acid (5-ASA), his skin eruptions were resolved, however, he developed weakness and atrophy in his right arm as well as progressive worsening of the dysesthesia in his legs and gait disturbance. Deep tendon reflexes (DTR) were absent in all extremities. After 5-ASA was discontinued, the polyneuropathy symptoms recovered gradually. This clinical course suggests that the sensorimotor polyneuropathy may have been caused by 5-ASA.     

Childhood chronic inflammatory demyelinating polyneuropathy associated with acquired scoliosis: a case report

An 11-year-old boy presented with progressive proximal muscle weakness and areflexia. He also had scoliosis with right convexity in the thoracic spine. Nerve conduction studies showed demyelination with conduction blocks. The level of protein in the cerebrospinal fluid was elevated. Magnetic resonance imaging of the lumbosacral spine showed enhancement and hypertrophy of the nerve roots. The patient responded well to steroids. The association of acquired scoliosis with chronic inflammatory demyelinating polyneuropathy has not been reported before.     

家族性淀粉样变性周围神经病一尸检病例的病理研究

目的 通过对一例家族性淀粉样变性周围神经病(FAP)中国家系的先证者进行解剖检查及外周血标本的DNA基因测序,总结分析先证者的临床特征,为加强对该病的了解提供参考. 方法 应用HE染色、刚果红染色、甲苯胺蓝染色后光镜下观察淀粉样物质沉积情况;同时行免疫病理方法偏振光显微镜下观察. 结果 本例先证者为TTR Val30Ala FAP型.先证者的周围神经、肝脏、睾丸、甲状腺、胰腺和肌肉中可见大量淀粉样物质沉积.脾脏改变轻微.中枢神经系统脑实质及脊髓内均无淀粉样物质沉积. 结论 研究结果显示国人TTR Val30Ala FAP病理变化特点与经典TTR Val30Met FAP有所不同.     

Chronic inflammatory demyelinating polyneuropathy with tongue fasciculation: A case report

Chronic inflammatory demyelinating polyneuropathy is one of the immune-mediated polyneuropathies responsive to immunotherapy. Its usual clinical presentation is a chronic course of symmetric sensorimotor affectation of both proximal and distal extremities with signs of demyelination on electrophysiologic studies. Cranial nerve signs in this condition is not commonly encountered, particularly involvement of the hypoglossal nerve. To date, there are only three published cases of hypoglossal involvement in this condition. This case report presents a patient with tongue fasciculation, which is an uncommon finding in chronic inflammatory demyelinating polyneuropathy. This paper highlights the importance of considering chronic inflammatory demyelinating polyneuropathy in the differential diagnoses of a patient with tongue fasciculation as it has been found to be responsive to immunotherapy in comparison to other lower motor neuron syndromes.     

Acute atypical polyneuropathy in chronic Chagas' disease: report of a case

The author reports the case of a 47-year-old man who developed an acute polyneuritis in the course of the chronic Chagas' disease. Neurological examination on admission forty-five days after onset showed total ptosis of the left eyelid without internal and external ophthalmoplegia. There was moderate diffuse weakness in the limbs. Tendon reflexes were depressed. Plantar responses were normal. The cerebrospinal fluid cell count and protein level were raised. The relationship between chronic Chagas' disease and peripheral polyneuritis is discussed.     

Giant-axon polyneuropathy (case report)

In a girl aged 8 years with clinical manifestations of polyneuropathy histological examination of the sural nerve demonstrated segmental distension of axons. The characteristic appearance of her hair, signs of peripheral nervous system damage and morphological findings in the sural nerve made possible the diagnosis of giant-axon polyneuropathy.     

病因为重叠综合征的多发性神经病1例报告

1临床资料 患者,女性,68岁,因四肢末端麻木乏力5个月,于2006年5月入院。入院前无明显诱因出现缓慢进展性四肢末端麻木,伴乏力、肿胀,僵硬（晨起时明显,持续1h以上）,最初为双手指末端麻木,渐进性出现全手、腕部、双足麻木及四肢末端怕凉、双手指及足趾皮肤变黑（以右端为重）,伴有全身大关节疼痛及多个指（趾）关节疼痛肿胀,曾于当地医院诊断为：“类风湿性关节炎”,经治疗（具体药物及剂量不详）后,病情无明显好转。既往史：有“淋巴结结核”史,已行手术切除;有“美尼埃氏病”史;1982年曾因左肩关节外伤于当地医院手术治疗,术中有输血史;平素全身皮肤易出现瘀斑。入院查体：神志清,四肢末端皮肤稍黑、发凉,四肢肌力稍低于5级,双侧肱二头肌反射、双膝反射活跃,双侧桡骨膜反射、双侧踝反射减弱,双侧病理征阴性。     

Chronic inflammatory demyelinating polyneuropathy associated with membranous glomerulonephritis: case report.

A case of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) with Membranous Glomerulonephritis (MGN) is reported. This is the second case recorded in the literature and the article compares this case with the other reported case, including immunological implications.     

Tacrolimus-related polyneuropathy: case report and review of the literature

Patients, in particular recipients of orthotopic liver transplants, receiving the immunosuppressant tacrolimus (FK-506), are at risk for developing central neurotoxic adverse events. We report the occurrence of a tacrolimus-induced peripheral neurotoxic event, i.e. pure motor axonal polyneuropathy of the lower limbs in a 44-year-old woman, 9 days after combined orthotopic liver and pancreas transplantation. She was treated for 5 days with intravenous immunoglobulins. Partial recovery followed over months to years. An overview of all 11 reported FK506-associated polyneuropathies is given.     

Central hypomyelination associated with congenital hypomyelinating polyneuropathy: report of an autopsied case

The central nervous system (CNS) findings associated with congenital hypomyelinating polyneuropathy (CHN) are not established due to a paucity of reported post-mortem examinations. In this report we describe the pathologic changes found in the peripheral nervous system and CNS in a 2 1/2-week-old infant with a clinical diagnosis of CHN who died of respiratory failure clinically attributed to phrenic nerve dysfunction. Macroscopic findings included striking hypoplasia of the corpus callosum and anterior commissure, cerebellum, crus cerebri, ventral pons and pyramids. Histologic and immunohistochemical findings included complete absence of myelin staining and myelin basic protein immunoreactivity (MBP-IR) in the cerebral hemispheres, cerebellum, brainstem, cranial nerves and spinal cord despite little or no detectable reduction in numbers of oligodendrocytes. A severe fibrillary astrocytosis was seen at each of these sites. A slight reduction in neurons was identified in the cerebellum and spinal cord but nowhere else in the brain. These findings raise the possibility that deficient or markedly delayed CNS myelination accompanies peripheral hypomyelination in some cases of CHN.     

胰岛素瘤致可逆性胼胝体压部病变综合征一例

正患者男性,36岁,主因反复出现的发作性意识障碍1年余、加重6 d,于2015年8月4日入院。患者1年前无明显诱因出现清晨反复发作性意识不清,仰卧位,无法唤醒,约2 h后自行恢复意识,清醒后无法回忆,发作时大小便失禁1次,无面色苍白、四肢抽搐、盗汗等,发作后遗留头部昏沉感、逐步自行缓解,偶连续数天均有发作。外院实验室检查空     

Wernicke-korsakoff encephalopathy and polyneuropathy after gastroplasty for morbid obesity: report of a case

BACKGROUND: Gastric partitioning is a surgical procedure for the treatment of morbid obesity that may engender neurological complications, such as Wernicke encephalopathy and polyneuropathy. SETTING: A specialist hospital. PATIENT: A 36-year-old woman developed Wernicke-Korsakoff encephalopathy and polyneuropathy 3 months after gastroplasty for morbid obesity. A magnetic resonance scan documented the diagnosis, and a clear improvement occurred after parenteral thiamine treatment. In our patient and in previously described cases of the literature, postsurgical vomiting is a constant finding that seems to be the precipitating factor of neurological complications of gastric partitioning. CONCLUSION: Persistent vomiting after gastroplasty for morbid obesity should be considered an alarming symptom to treat immediately with appropriate measures.     

Familial amyloid polyneuropathy: report of a family

We report an Italian family affected by familial amyloid polyneuropathy. In two siblings, the diagnosis was confirmed by skin biopsy which revealed an unusual involvement of cutaneous nerves. Immunohistochemical studies confirmed the presence of prealbumin in the amyloid deposits.     

Sarcoid polyneuropathy: a histologically proved case

A 58-year-old patient had subacute polyneuropathy. Electrophysiological studies showed inexcitability of the distal portion of the peroneal and posterior tibial nerves and minimal reduction in amplitude of the muscle potential with minimal slowing in motor nerve conduction velocity. The sural nerve biopsy showed multiple sarcoid granulomas in the epineurial and perineurial spaces, periangiitis and panangiitis, and axonal degeneration. Remarkable clinical improvement followed corticosteroid treatment.