Abstract Details

Title Alcohol-Related Acute Axonal Polyradiculoneuropathy Mimicking Guillain-Barre Syndrome

Topic Peripheral Nerve

Presentation(s) P07 - (-)

Poster/Presentation
Number 061

Objective

Background BACKGROUND: In contrast to peripheral polyneuropathy which is a well-known complication of chronic alcohol overuse, acute polyradiculoneuropathy mimicking Guillain-Barre syndrome is less well-recognized but should be considered in the appropriate clinical context.

Design/Methods DESIGN/METHODS: Case Report- A 37 year old lady presented with bilateral lower extremity weakness of 3 weeks duration. She first noticed dull achiness and numbness to both thighs and anterior abdomen. Weakness affecting both hips and thighs occurred over the subsequent 4-5 days with numbness of bilateral fingertips. There were no antecedent symptoms of infection. Because of a history of heavy alcohol intake (0.5-1 pint of liquor/day x 2 years), she was referred for evaluation of suspected alcohol myopathy. Examination revealed moderate, symmetric, proximal weakness affecting hip and shoulder girdle muscles with mild, asymmetric weakness affecting the distal extremities. Deep tendon reflexes were absent in both lower extremities and normal in bilateral upper extremities. Sensation to all modalities was moderately diminished bilaterally from mid-leg distally. Station and gait features suggested a moderate sensory ataxia.

Results RESULTS: An MRI of the lumbar spine was unremarkable. Electrodiagnostic studies demonstrated an acute, diffuse axonal polyradiculoneuropathy, much worse in the lower extremities. There was no evidence of a demyelinating or myopathic process. Cerebrospinal fluid studies showed: RBC: 29mm/3, WBC: 1mm/3, protein: 67mg/dL, glucose: 55mg/dL. There was a moderate transaminitis and a low thiamine level (59 nmol/L). With alcohol cessation, the patient received intravenous immunoglobulin, thiamine replacement and physical therapy with marked improvement in deficits.

Conclusions CONCLUSIONS: Acute ascending quadriparesis with areflexia and albumino-cytological dissociation in a thiamine-deficient alcoholic, may closely mimic Guillain-Barre syndrome but may represent an acute axonal polyradiculoneuropathy. Prompt electrodiagnostic studies are important to differentiate between these two conditions requiring different management approaches.

Authors/Disclosures
John A. Morren, MD, FAAN (Cleveland Clinic) PRESENTER	Dr. Morren has received publishing royalties from a publication relating to health care.
Nimish Thakore, MD (Cleveland Clinic)	No disclosure on file
Yuebing Li, MD, PhD, FAAN (Cleveland Clinic)	Dr. Li has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Argenx. Dr. Li has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen. Dr. Li has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Vertex. The institution of Dr. Li has received research support from Argenx.
Federica Agosta (San Raffaele Scientific Institute)	Federica Agosta has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Philips. Federica Agosta has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier INC.

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