Abstract

A 62-year-old gentleman presented in 2009 with pain, numbness and tingling in the right hand and arm. Neurological examination revealed reduced light touch and pain sensation in the C8 dermatome. Significant past medical history included neck trauma in 1989, managed by C4/5 and C5/6 cervical decompression. MRI revealed only mild alkylotic changes at C4/5, and coincidental L4/5 stenosis. Haematinics, serum electrophoresis, glucose, ACE level, vasculitic screen and Lyme serology were all normal. In March 2010 his C8 symptoms continued, grip strength deteriorated and he developed corresponding muscle wasting. This significantly affected his job as a photographer. LP at this time revealed a raised protein, at 0.7, no oligoclonal bands, and normal glucose and cytology. He was treated with immunoglobulin for a presumed autoimmune disorder affecting the right C8 root. In April 2011 he underwent neurophysiological testing which demonstrated a preganglionic right C8/T1 lesion, and florid signs of denervation in the right C8 territory with frequent fibrillations and sharp waves. The median and ulnar nerves were normal. There was also extensive slowing of the common peroneal nerve across the ankle. The findings were in keeping with a demyelinating peripheral polyneuropathy. Methylprednisolone was started and, to date, his symptoms remain stable. In summary, I present a case of CIDP presenting with a right C8 radiculopathy.