PDF(Pubmed)
Abstract：
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare relapsing-remitting autoimmune polyneuropathy that targets peripheral nerves and has been associated in the literature with sarcoidosis. The goal of this study is to report the clinical case of a 61-year-old man with sarcoidosis who developed CIDP following lumbar spine surgery. The patient presented at their clinic visit with lumbar back pain and underwent a dome laminoplasty at L2-3, L3-4, and L4-5 with no known complications. Approximately four hours postoperatively, he developed bilateral lower extremity weakness most prominent along the tibialis anterior and extensor hallucis longus (L4-S1) as well as saddle anesthesia. An MRI revealed no acute changes concerning compression. Electromyography (EMG) was performed six months postoperatively, which revealed absent F waves along the peroneal and tibial nerves as well as decreased amplitude consistent with an underlying axonal neuropathy. He was referred to a neurologist for a second opinion where a diagnosis of CIDP was made. Intravenous immune globulin treatment was initiated, and the patient felt improvement in his symptoms. This case highlights the association between sarcoidosis and CIDP and discusses the pathophysiology of the disease. In patients with sarcoidosis and weakness following lumbar surgery with a negative MRI, CIDP should be on the differential.
摘要：
慢性炎症性脱髓鞘性多发性神经病（CIDP）是一种罕见的复发缓解性自身免疫性多发性神经病，靶向周围神经，在文献中与结节病有关。这项研究的目的是报告一名61岁结节病患者在腰椎手术后发展为CIDP的临床病例。患者在临床就诊时出现腰背部疼痛，并在L2-3，L3-4和L4-5进行了圆顶椎管成形术，无已知并发症。术后约4小时,他在胫骨前肌和长伸肌（L4-S1）以及鞍状麻醉中出现了最突出的双侧下肢无力。MRI未显示有关压缩的急性变化。术后6个月进行肌电图（EMG）检查，显示腓骨和胫神经没有F波，振幅降低与潜在的轴索神经病一致。他被转介给神经科医生以获得第二意见，并诊断为CIDP。开始静脉免疫球蛋白治疗，病人感觉到症状有所改善。该病例强调了结节病与CIDP之间的关联，并讨论了该疾病的病理生理学。在MRI阴性的腰椎手术后结节病和无力的患者中，CIDP应该在差分上。
