Acute combined central and peripheral demyelination A rare case report

Demyelinating disorders are common, but infrequently, combined involvement of central and peripheral nervous system with demyelinating process have been described. We describe a patient who had a both of central demyelination associated with an acute radiculopolyneuropathy.Case ReportAn otherwise healthy 17-year-old woman presents to the emergency departmentwith progressive weakness that began 3 days earlier. She reports difficulty walking,numbness in the body below her breasts, and urinary retention. She also reports gastroenteritis two weeks ago. Neurologic examination reveals normal sensorium and intact cranial nerves. Tetraplegia with generalized hyporeflexia, a left extensor plantar response, impairment of vibratory and proprioceptive sensation, and a sensory level at T4. Brain MRI reveals a few scattering high signal intensities at white matter and left cerebellar peduncle. MRI of cervical cord showed lesion at C5-C7 levels that minimal enhances after gadolinium administration, a finding that is consistent with longitudinal extensive transverse myelitis. EMG and NCV findings are consistent with myeloradiculopathy. CSF analysis, IgG index, OCB, NMO and MOG antibodies titers and other tests are unremarkable. Pulse Methyl Prednisolone 1 gr/day was started for five days with weakly response. The patient was treated with Plasma Exchange and then IVIG. The forces of limbs were increased.Discussion and ConclusionOur patient presented with a constellation of neurological symptoms, including flaccid weakness of the upper and lower limbs, extensor plantar reflexes, generalized hyporeflexia which were consistent combined central and peripheral demyelination.