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NCS demyelinating neuropathy — SCE Neurology MCQ

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HardNeurological InvestigationsNCS demyelinating neuropathySCE Neurology

A patient has progressive symmetrical proximal and distal weakness, sensory loss and areflexia over four months. Nerve conduction studies show demyelinating-range slowing and conduction block; CSF protein is raised without pleocytosis. Which initial disease-modifying treatment is appropriate?

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Correct answer: A — Intravenous immunoglobulin or corticosteroid treatment for CIDP

The best answer is “Intravenous immunoglobulin or corticosteroid treatment for CIDP”. The time course, examination and acquired demyelinating physiology support CIDP; IVIg or corticosteroids are first-line options, while plasma exchange is effective when these are unsuitable or insufficient. “Long-course antimicrobial therapy for presumed infectious neuritis” is less appropriate because the syndrome lacks evidence for bacterial nerve infection “Levodopa treatment for peripheral conduction-block weakness” is less appropriate because dopamine replacement does not remyelinate peripheral nerves “Carotid endarterectomy for a presumed embolic motor syndrome” is less appropriate because carotid surgery has no target in a diffuse polyradiculoneuropathy “Repeated thrombolysis for episodic demyelinating weakness” is less appropriate because thrombolysis neither treats chronic symmetric weakness nor conduction block

Reference: EAN/PNS guideline on diagnosis and treatment of CIDP. https://onlinelibrary.wiley.com/doi/10.1111/jns.12455