inflammatory polyneuropathy

I have posted earlier concerning complicated migraine vs. TIA. My neuro has ruled out TIA and MS (through LP and MRI)and ALS (through NCV/EMG). However, for about a month now I have been getting progressively weaker in the legs and arms. I can no longer exericise since it makes my weakness more pronounced. I also experience buzzing in my legs with some uncontrolled tremor in the leg at night. Besides the weakness, the back of my head feels heavy and causes a bit of disequilibrium. I also have a probable small (2mm) syrinx at C6-7 that my doc thinks is probably not causing the problems. The EMG/NCV were mildly abnormal and my protein level from LP was 48. My doc is not sure what is wrong but is now working with a dx of inflammatory polyneuropathy. He says its a hard diagnosis to make and wants to wait to get another cervical MRI to rule out syrinx growth as cause in a few weeks. Meanwhile, I'm getting worse. I was an active athlete just 5 weeks ago and now have trouble walking any long distance due to weakness. Does inflammatory poly neuropathy sound plausible and if so, what are the treatment options. My neuro was also suggsting a second opinion consult in Boston (I'm in Maine)with a neuromuscular specialist. Any recommendations on such a facility in Boston? Finally, what else could be causing my problems. Thank you very much.

[CCF-Neuro-M.D.-JT]

Sorry to hear about your symptoms. Your doc's suspicions are strong possibilities. The protein level in the spinal tap is only mildly elevated (depending on the normal range specifically at the lab where your fluid was sent, 45 at our lab), but if done less than a week from the onset of symptoms may not have had time to rise. This is also true for the EMG, if done too early it wil be normal. If the symptoms have only been going on for a few weeks to a month, then it could be Guillain Barre syndrome which is also known as acquired inflammatory demyelinating polyneuropathy. This is thought to be a disease related to the immune system in which the coverings (or myelin) of your nerves outside of the brain and spinal cord are being attacked y your own immune system. Did you have a recent cold/flu or diarrhea prior to this? In most cases, the symptoms get better on their own with time. BUt there is treatment out there with IVIg (IV immune globulin to "counteract" the abnromal antibodies or plasmapheresis (like dialysis where they filter out all abnormal anitbodies), so diagnosis is very important.
If the symptoms were longer, then it could be CIDP or chronic inflammatory demyelinating polyneuropathy which is similar to above and is treated with steroids. An expanding syrinx is certainly another possibility as well as any other type of spinal cord disease.
Other polyneuropathies are possible too, What will be important is the neuro exam (reflexes!) and possibly a repeat EMG if there is objective evidence of weakness on the exam. I agree with your doc's suggestions. You can't go wrong with Mass General Hosp in Boston (Harvard) and should also consider Dr. Allan Ropper who is chairman at Tufts (also in Boston) and is a well-respected expert on demyelinating polyneuropathies. He is extremely bright, very personable, but may be difficult to get an appointment with. GOod luck.

[sunclaud]

A related discussion, CIDP was started.