2023 American Academy of Neurology Abstract Website

Objective:

The objective of this case report is to present a case of acute immune mediate demyelinating polyneuropathy (AIDP) triggered by an intracranial hemorrhage (ICH), which was identified by early loss of brainstem reflexes.

Background:

AIDP is a phagocytic attack on Schwann cells and/or myelin in the peripheral nervous system, resulting in decreased nerve conduction and acute denervation. AIDP has rarely been observed with intracranial hemorrhage or ischemic stroke. Moreover, a diagnosis of fulminant AIDP with a clinical picture of brain death has only been previously described in few case reports, and never in the setting of intracranial hemorrhage.

Design/Methods:

This is a case report, where we describe a patient who underwent ICH evacuation which progressed to fulminant AIDP with loss of brainstem reflexes.

Results:

A 79-year-old female who presented with acute onset left hemiparesis was admitted to the ICU after evacuation of a right frontal-parietal ICH. Two weeks after, the patient’s neurological exam showed an acute loss of corneal, gag and cough reflexes, bilateral mydriasis and flaccid quadriplegia with areflexia. Repeat imaging did not reveal injury that would explain the change in clinical status. A lumbar puncture revealed albumino-cytologic dissociation. Serum studies returned positive for anti-GM1 and TPO antibodies. EMG revealed multiple absent motor and sensory conduction responses and decreased amplitude and conduction velocity. She was treated with intravenous immunoglobulin and plasma exchange therapy. Over the course of one week, she gradually recovered her reflexes, motor strength and became responsive to medical care.

Conclusions:

While the patient's apparent comatose state and absent brainstem reflexes was suspicious for brain death, the severity of her hemorrhage was not consistent with it. Our diagnosis of fulminant AIDP was based on a combination of neurological examination, lumbar puncture and EMG studies and allowed for effective treatment and recovery of a patient showing signs of apparent brain death.