Anesthesitic management for insulinoma resection in a patient having chronic inflammatory demyelinating neuropathy / Manejo anestésico para resección de insulinoma en un paciente portador de neuropatía desmielinizante crónica

Chronic Inflammatory Demyelinating Polyneuropathy associated with hypoglycemia 2 to insulinoma is unusual, and to our knowledge, very few patients have been reported in literature. Despite varying presentations in these patients, the clinical characteristics are usually the same. The syndrome usually occurs after several episodes of protracted hypoglycemia. The neuropathy is nearly always symmetrical. We report anesthetic management for a young female patient presenting with CIDP & repeated hypoglycemic episodes during a 2-year period scheduled for insulinoma enucleation.

La polineuropatía desmielinizante inflamatoria crónica asociada con hipoglicemia secundaria a insulinoma es inusual y, hasta donde sabemos, muy pocos pacientes han sido reportados en la literatura. A pesar de las diferentes presentaciones en estos pacientes, las características clínicas suelen ser las mismas. El síndrome generalmente ocurre después de varios episodios de hipoglicemia prolongada. La neuropatía es casi siempre simétrica. Presentamos el manejo anestésico para una paciente joven que se presenta con polineuropatía desmielinizante inflamatoria crónica y episodios repetidos de hipoglicemia durante un período de 2 años programado para la enucleación de insulinoma.

Acute Onset Chronic Inflammatory Demyelinating Polyneuropathy: A Case Series Of 4 Patients From Tertiary Care Center

Acute onset CIDP(A-CIDP) is an often unrecognized CIDP variant which needs differentiation from Guillain -Barre syndrome(GBS) due to its different prognostic and treatment outcomes. METHODS: We report clinical course and investigations including electrophysiology of 4 patients of A-CIDP and comparison with Electrophysiology of 20 GBS patients. RESULTS: Four patients with initial GBS like clinical presentation were later diagnosed as A-CIDP. Three patients improved with immunotherapy but had exacerbation of weakness more than 8 weeks later while one patient had subacute onset progressive weakness. These patients were further managed with steroids and maintenance immunotherapy. CONCLUSION: GBS is diagnosed on the basis of clinical and electrophysiological criteria and managed with IVIg. Although some clinical features and initial electrorophysiology can suggest the possibility of A- CIDP, the diagnosis is conrmed on follow up only.

Chronic Inflammatory Demyelinating Polyradiculoneuropathy Associated with Membranous Glomerulonephritis and Tendinitis

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated progressive or relapsing demyelinating peripheral neuropathy. Other autoimmune diseases may be associated with CIDP. A 38-year-old man developed CIDP, which was subsequently associated with membranous glomerulonephritis (MGN) and tendinitis. He was treated with intravenous immunoglobulin, rituximab, and prednisone, which resulted in improvement of the clinical symptoms. This is a case report of CIDP associated with MGN and tendinitis.

Clinical characteristics of chronic inflammatory demyelinatingpolyradiculoneuropathy in diabetes patients

Background & Objective: Co-exiting of CIDP and diabetes mellitus had been reported. Idiopathic CIDP(I-CIDP) is a treatable disease and had favorable response to immunosuppressive therapies but there is no established data for CIDP in diabetic patients (DM-CIDP). This study aims to determine clinical characteristics, phenotypes, electrophysiological tests and treatment response of CIDP in diabetic patients; and to determine the response to immunosuppressive therapy in DM-CIDP and I-CIDP. Methods: The study was a retrospective chart review of Prasat Neurological Institute patients with diagnosis of CIDP between January 1st, 2008 and December 31th, 2015. Results: Sixty four CIDP patients were identified, 12 were DM-CIDP and 52 were I-CIDP. Clinical characteristics, phenotypes, disease duration and disease severity in DM-CIPD were not different from I-CIDP. Demyelinating changes in nerve conduction studies were not different in the two entities but axonal features were more predominant in DM-CIDP. DM-CIDP also responded to immunosuppressive treatment, with modified Ranking Scale decreased after treatment as in I-CIDP. There was no difference in treatment response in DM-CIDP and I-CIDP. Conclusion: Clinical characteristics, phenotypes, disease severity and treatment response to immunosuppressive treatment in DM-CIPD were not different from I-CIDP. Demyelinating features in nerve conduction studies were not different in the two entities but axonal features were more predominant in DM-CIDP.

Polineuropatía asociada a infección por VIH. Revisión del tema ypresentación de un caso / Polyneuropathy associated to VIH infection. Review of the topic and case report

La infección por el virus de inmunodeficiencia humana (VIH) constituye un problema de salud pública. Laafectación neurológica en los pacientes infectados por el VIH es frecuente, involucrando tanto al sistema nerviosocentral como al periférico, y en algunos casos puede ser la primera manifestación de la infección. Entrelas afecciones neurológicas, las neuropatías periféricas pueden observarse en el 100% de las autopsias. Lasmismas pueden adoptar diferentes formas, que por lo general dependen de la fase de la enfermedad en la quese encuentre el paciente. Las neuropatías autoinmunes como el síndrome de Guillain-Barré y la polineuropatíadesmielinizante inflamatoria crónica (CIDP) aparecen en los estadios iniciales de la infección, cuando el conteode CD4 está ligeramente disminuido. La CIDP tiene criterios clínicos y electrofisiológicos bien definidos quela diferencian de otras formas de neuropatías periféricas, responde bien al tratamiento inmunomodulador,pero su diagnóstico puede ser difícil de realizar debido a su forma insidiosa de comienzo. Se realiza una breverevisión de las neuropatías periféricas que pueden asociarse a la infección por VIH y se presenta un caso deasociación de esta infección con CIDP.

Infection by Human Immune deficiency (VIH) is a public health problem. Neurological affection in those patients is frequent, it involve central and peripheral nervous system. In some cases neurological involvement is the first sign of the infection. Peripheral neuropathies are the most common of neurological illness associated to VIH infection; it could be observed in 100 % of autopsy. Autoimmune neuropathies like Guillain Barré and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) appear at initial phase of infection, when CD4 count is slight diminish. CIDP has defined clinic and electrophysiological criteria to differentiate it from other types of neuropathies, CIDP has a good response to immunomodulation treatment, it has an insidious start, which could difficult the diagnostic. We show a brief revision of peripheral neuropathic associated to VIH infection; we show a case with VIH infection and CIDP.

Chronic inflammatory demyelinating polyneuropathy: quality of life, sociodemographic profile and physical complaints / Polineuropatia inflamatoria desmielinizante cronica: qualidade de vida, perfil sociodemografico e queixas fisicas

Whereas an evaluation of quality of life and possible impacts on the mental state of a patient may help to evaluate the evolution of chronic inflammatory demyelinating polyneuropathy (CIDP), the aim of this study was to study the psychological profile of patients, and evaluate quality of life associated with the disease. Method 41 patients were evaluated using a Mini-Mental State Examination (MMSE) and a Short-Form Health Survey (SF-36). Results The mean age of the patients was 50.6 years, 63.4% men. Of the participants, 65.9% had other health problems, 39% reported needing help with activities of daily living, 49% slept less than 8 hours per night, and 34.1% complained of some memory deficit. The average MMSE score was 26. Impairment of functional capacity and pain were the more important altered health states. Conclusion CIDP has important social and economic impacts, owing to functional impairments that can lead to professional and personal limitations. .

A avaliação da qualidade de vida (QV) e dos possíveis impactos dos déficits funcionais sobre o estado mental de pacientes com polirradiculoneuropatia inflamatória desmielinizante crônica (PIDC) pode contribuir para a melhor compreensão de aspectos evolutivos da doença. A presente investigação teve como objetivo estudar as atividades da vida diária depacientes com PIDC e avaliar a sua QV. Método Foram avaliados 41 pacientes através do Mini Exame do Estado Mental (MEEM) e do inventário de saúde SF-36®. Resultados A média de idade dos participantes foi 50,6 anos, 63,4% homens. Problemas adicionais de saúde foram referidos por 65,9%: 39% relataram necessitar de ajuda para atividades de vida diária, 49% dormiam menos de 8 horas por noite e 34,1% referiam alguma dificuldade de memória. A média do MEEM foi 26. Através do SF-36 foi verificado maior prejuízo na capacidade funcional; a referência a dor foi proeminente. Conclusão A PIDC pode ter importante impacto social e econômico em decorrência dos prejuízos funcionais primários e secundários que podem levar ao afastamento do trabalho. .

Polineuropatía desmielinizante inflamatoria crónica: Aspectos clínicos y electrofisiológicos / CIDP: Clinical and electrophysiological aspects

La polineuropatia desmielinizante inflamatoria crónica (CIDP), por sus siglas en inglés, es una polineurorradicu-lopatía predominantemente motora de etiología autoinmune. Su comienzo es insidioso y el curso crónico, afecta tanto a hombres como a mujeres con un ligero predominio en los primeros. Puede aparecer en cualquier etapa de la vida, es más frecuente a partir de la segunda década. Es necesario diferenciarla de otras enfermedades, ya que es potencialmente tratable, con buena respuesta a los inmunosupresores. Su diagnóstico se sustenta en cuatro pilares: la clínica, los estudios neurofisiológicos, el estudio del líquido cefalorraquideo y los análisis anatomopatológicos. Desde su descripción inicial se han planteado numerosos criterios diagnósticos, aspecto polémico y controversial, ya que en la práctica clínica existen numerosos pacientes que no cumplen estrictamente con estos criterios pues presentan casos atípicos. Por la dificultad en el diagnóstico de esta patología se realizó una revisión del tema, exponiendo los principales aspectos clínicos, electrofisiológicos, fisiopatológicos y anatomopatológicos, junto con una breve exposición de lo hallado en doce años de experiencia con esta patología en la Habana, Cuba.

Chronic demyelinating inflammatory polineuropathy (CIDP) is a kind of peripheral neuropathy predominantly motor of autoimmune cause and chronic course. Its start insidiously, it can affect both sex, more frequent male. It can appear in any time of life more frequent in second decade. It is very important differentiate of other illness because it has good response to inmunosupresor agents. Diagnosis is support ed in four aspects: clinical, electrodiagnostic studies, brain spinal fluid study and anatomo-pathologycal issues. Diagnosis is polemic and controversial, with different diagnosis criteria, because they not include atypical variants. We have to review ed this topic, and show clinical, electrophysiological, fisiopathological and pathological aspects and also our experience in the study of CIDP patients throw twelve years in La Habana, Cuba.

Sensory Ataxia Form of Chronic Inflammatory Demyelinating Polyneuropathy / 浙江中医药大学学报

[Objective] To explore the clinical characteristics and pathogenic mechanism of sensory ataxia form of GBS.[Methods] To Summarize clinica1 data of 19 cases with sensory ataxia form of GBS.[Result] The main clinical manifestations were sensory ataxia.The disease relieved and recurred easily and had long course.The protein in CSF increased significantly.Pathological feature was same with general CIDP.Treatment of glucocortieoid was satisfied.[Conclusions] Sensory ataxia form of GBS was one sub-type of CIDP.Pathogenic mechanism was perhaps that immunoreaction attacked proproioceptive sense fibre of radix dorsalis.