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Acute combined central and peripheral inflammatory demyelination
  1. J Katchanov1,
  2. J D Lünemann1,
  3. F Masuhr1,
  4. D Becker1,
  5. M Ahmadi1,
  6. J Bösel1,
  7. R Zschenderlein1,
  8. S Bamborschke2,
  9. R Klingebiel3
  1. 1Departments of Neurology, University Hospital Charité, Humboldt-University, Schumannstr. 20/21, 10117 Berlin, Germany
  2. 2Department of Neurology, Brandenburg-Klinik, Brandenburgallee 1, 16321 Bernau-Waldsiedlung, Germany
  3. 3Department of Radiology, Neuroradiology Section, University Hospital Charité, Humboldt-University, Schumannstr. 20/21, 10117 Berlin, Germany
  1. Correspondence to:
 Dr J Katchanov
 Klinik fuer Neurologie, Campus Charité Mitte, Schumannstr. 20/21, D-10117 Berlin; juri.katchanovcharite.de

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Generally, inflammatory demyelinating diseases selectively affect either the central or peripheral myelin. Here we report a case of a severe combined central and peripheral demyelination, each of which contributed equally to the clinical syndrome.

Case report

A 32 year old female was admitted to a general district hospital with a 3 day history of aches in the legs, fever (38 °C), urinary retention and leg weakness. Neurological examination revealed a flaccid tetraparesis with abolished abdominal and ankle reflexes, diminished knee reflexes, bilateral extensor plantar responses, and sensory level at T12. The patient was given high dose intravenous prednisone (1 g) for 5 consecutive days. She became bedridden with complete paraplegia of the legs and was referred to our department. Upon admission, in addition to a flaccid tetraparesis (strength 1/5 in the legs and 4/5 to 4±5 in the arms, MRC grade) with abolished abdominal, knee and ankle reflexes, extensor plantar responses, and sensory level at T5, a bilateral gaze evoked nystagmus was detected. Urodynamic examination revealed an atonic bladder. Lumbar puncture revealed a pleocytosis (34/mm3; 84% lymphocytes) and a cerebrospinal fluid (CSF) protein of 132 mg/dl. Neither intrathecal immunoglobulin synthesis nor oligoclonal bands were detected. Complete microbiological and virological investigations on CSF and blood …

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Footnotes

  • Competing interests: none declared