1118 - Who Done It? Atypical Presentation of CIDP and Cauda Equina Syndrome

Case Diagnosis: Chronic Inflammatory Demyelinating Polyneuropathy, Cauda Equina Syndrome

Case Description: 35 yo female with G6PD deficiency presented after viral illness with right facial droop and oral sensation loss, diagnosed with Bell’s palsy, treated with prednisone and acyclovir and discharged home.
She subsequently developed lower extremity weakness and upper extremity paresthesias. L4/5 lumbar puncture revealed albuminocytologic dissociation, consistent with Guillain-Barre syndrome. Patient underwent 5 sessions of IVIG and was discharged to acute inpatient rehabilitation (AIR). She later developed severe leg pain and spasms requiring transfer to acute care, where she was found to have an L1 ventral intradural hematoma causing severe nerve root compression. She underwent T12-L2 laminectomy and hematoma evacuation with improvement in symptoms and returned to AIR. Weeks later, electrodiagnostic studies were completed, which suggested an etiology of cauda equina and chronic inflammatory demyelinating polyneuropathy (CIDP) rather than acute inflammatory demyelinating polyneuropathy (AIDP). She was treated with a 3-day course of IV Methylprednisolone with further improvement in motor strength.

Discussions: This patient had multifocal overlapping lower motor neuron pathologies, ultimately complicating diagnosis, treatment and prognostication of her recovery. Her treatment drastically changed as her diagnoses shifted from AIDP to CIDP and cauda equina syndrome. Her mixed pathology complicated bowel and bladder management, though she ultimately regained voluntary bowel and bladder control.

Conclusions: This case highlights the importance of complete evaluation of spinal cord injuries and how multiple, concomitant pathologies can complicate and alter prognosis, treatments and future medical care.