Long-Lasting Cranial Nerve III Palsy as a Presenting Feature of Chronic Inflammatory Demyelinating Polyneuropathy

Abstract EN

We describe a patient with chronic inflammatory demyelinating polyneuropathy (CIDP) in which an adduction deficit and ptosis in the left eye presented several years before the polyneuropathy.

A 52-year-old man presented with a 14-year history of unremitting diplopia, adduction deficit, and ptosis in the left eye.

At the age of 45 a mild bilateral foot drop and impaired sensation in the four limbs appeared, with these symptoms showing a progressive course.

The diagnostic workup included EMG/ENG which demonstrated reduced conduction velocity with bilateral and symmetrical sensory and motor involvement.

Cerebrospinal fluid studies revealed a cytoalbuminologic dissociation.

A prolonged treatment with corticosteroids allowed a significant improvement of the limb weakness.

Diplopia and ptosis remained unchanged.

This unusual form of CIDP presented as a long-lasting isolated cranial nerve palsy.

A diagnostic workup for CIDP should therefore be performed in those patients in which an isolated and unremitting cranial nerve palsy cannot be explained by common causes.