Concurrent acute motor and sensory axonal neuropathy and immune thrombocytopenic purpura.

BACKGROUND: Guillain-Barré syndrome (GBS) is a potentially life-threatening autoimmune disease causing demyelination of peripheral nerves. Multiple variants of GBS exist, with acute motor and sensory axonal neuropathy (AMSAN) being the most severe. GBS typically does not occur in the setting of other autoimmune diseases; however, few case reports do exist describing the occurrence. METHODS: We describe a patient with acute motor and sensory deficits and thrombocytopenia, ultimately diagnosed with concurrent AMSAN and immune thrombocytopenic purpura (ITP). RESULTS: A 75-year-old woman presented with new onset diplopia and gait instability, however, was found to have a severe thrombocytopenia. Corticosteroids were initiated for ITP and intravenous immunoglobulin for apparent GBS. Nerve conduction studies and her clinical course indicated that she likely had AMSAN. Although her platelet count recovered, her neurologic status remained poor, prompting therapy with plasmapheresis with subsequent mild improvement. CONCLUSION: A review of the literature revealed eleven previous cases of concurrent GBS and ITP; however, we report the first case of concurrent AMSAN and ITP. Among these cases, trends were noted to include sex, preceding infections, and cranial nerve involvement.

Evidence-based medicine: specific skills necessary for developing expertise in critical appraisal.

The concept of evidence-based medicine (EBM), defined as the integration of best research evidence with clinical expertise and patient values, is essential to the review, understanding, and application of clinical principles into the practice of medicine. Critical appraisal includes recognizing and evaluating various study designs and their ranking in order of priority, judging relevance to the question at hand, identifying potential sources of bias, and determining whether the data presentation, statistical analysis, and conclusions are appropriate. The focus of this article is on the quality of the evidence and how each step in critical appraisal is important to the overall concept and application of EBM.