Quote:
Originally Posted by glenntaj
--my first thought with a rapidly ascending neuromuscular disturbance would be Guillian Barre syndrome, or one of its variants, including a possible attach or re-attack of chronic inflammatory demyelinating polyneuropathy, an autoimmune waxing/waning entity that is related to Guillain Barre (it's often considered, the "slower", more chronic form of that condition).
The recent prior history of infection also supports that idea, as a prior infection can often set off the immune molecular mimicry that leads to the neurological attack and symptoms.
Don't know why the EMG results should preclude the lumbar puncture in a case like this either--especially if the EMG showed nerve compromise.
I'm assuming MRI's were done to rule out obvious spinal cord issues--was one done of the brain as well? Often, in cases like this, another possibility is MS or another central nervous system demyelinating disease, such as acute disseminated encephalomyelitis (ADEM--these are distinct from demyelinating conditions of peripheral nerve such as Guillain Barre).
It really sounds like you need to get him to a (better) teaching hospital. The problem now, though, is that with Guillain Barre and similar syndromes the initial attack may be over and there may be less evidence to find, even if there are residual affects; has he improved?
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He has supposedly slightly improved today, but I think it's most likely the comfort and quiet of home as opposed the the smorgasbord of opiates, tv watching roommates, and interns jabbing his spine with needles at the hospital.
Thanks for the info on CIPD, sounds like it could be a possibility, I'll definitely research it more.
I would assume an MRI was done to check for spinal chord injury and brain tumor, but I don't know what images were actually taken and what was checked. MS was "ruled out" in that it was quickly diagnoses as "Peripheral Neuropathy." How that would be diagnostically separated by a doctor in his office from central neuropathy, I do not know.
No genetic test for HNPP was done.
I'm going to try and get HMO to get him a referral to the UCSF Neuropathy Center. Prolly gonna have to pull out the pliers and blow torch to get them to do it.
@mrsD He's wasn't taking medication of any kind at all, nor has he for basically his entire life. I completely agree I need to get my hands on his B12 counts, regardless if this has been caused by B12 deficiency or not, making sure his body is populated with the necessary materials for neurological health is essential. AFAIK he didn't eat any chicken prior to his stomach "flu," but I'll check. There was potentially some under cooked chicken like a ~week~ prior to his stomach flu. At any rate he did not even slightly suspect the chicken due to the the latency and food poisoning usually being quite rapid after ingestion.
@Susanne C. I guess what I meant with his elbows and shoulders is they seem to be the joints about which movement is difficult, like he "sets" his elbow to the right angle and can leave it there, but not really move it, not much range in the shoulder to lift either. Does this sort of rapid, progressive, and broad onset strike you as odd for HNPP? There's a bit more evidence related to this that I'm posting
Four other things I should mention:
He had a sort of episode with his wrist I want to say approximately a year ago that took about 5-6mo to go away. He had some pretty intense pain when applying pressure with his palm, or rotating it certain direction. The exact distinction I don't know. He said it felt almost like a bone fracture, but it could have been neural.
When he was 20 (~35 years ago,) he went on a backpacking trip, and had a strap too tight on his left shoulder, apparently this led to some extreme weakness and numbness following the trip, from which he recovered, but he said he always felt like that arm was weaker (also potentially double jointed.) This is the same arm that had the episode in 2008, but is now mostly functional (left.)
Keratosis on the skin (for some time now) but apparently almost all 50+ white people do.
He had a dental implant (titanium post deal) about a year ago (with bovine bone graft.)
Again thank you all very much. I'm quite touched by the number of detailed and thoughtful responses.
--Sam