Acute Inflammatory Demyelinating Polyneuropathy (AIDP)¶
Background¶
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Rapid onset polyneuropathy that manifests most often with ascending weakness and numbness that can involve the respiratory and facial musculature
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Usually preceded by infectious illness a few weeks prior
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Patients are much more likely to get AIDP from an infection than any vaccine, weak vaccine links to AIDP are an addition 1-2 cases per million flu vaccines.
Presentation¶
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Acute, progressive extremity weakness, weak or absent reflexes, and potentially subjective sensatory changes, especially back pain
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There are a TON of variants of AIDP, with some having cranial nerve weakness early, proximal weakness, sensory ataxia, primarily sensory loss, or rapid muscle weakness; do not use lack of classic ascending weakness to dismiss the idea of AIDP
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Sensory loss is common in an ascending pattern too
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Evaluation¶
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LP – albuminocytologic dissociation = high protein with normal cell count
- One exception is HIV, which can cause AIDP but also have a high cell count and high protein count
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EMG/NCS
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Demyelinating pattern (temporal dispersion and decreased conduction velocities).
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This can be normal in the first few days, and is most useful 2+ weeks out if the diagnosis is still unclear
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Differential diagnosis: spinal cord lesions, LEMS, MG, acute HIV or HCV, viral myelitis (entero/West Nile)
Management¶
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ABCs! NIF at baseline then Q4-6 hours
- NIF \< -30 with good effort generally warrants ICU monitoring
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IVIG or PLEX
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Can get worse with steroids