Effect of Intravenous Immunoglobulin on Bilateral Sixth Nerve Palsy in Chronic Inflammatory Demyelinating Polyneuropathy: A Case Study
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an immune mediated demyelinating disorder, which involves both sensory and motor peripheral nerves. Cranial neuropathy is a rare manifestation in CIDP patients. In this study, we describe a case of relapsing CIDP presented with acute onset bilateral sixth nerve palsy after being in remission for eight years. A 23-year-old man, with symmetric paresis of lower limbs that gradually evolved to upper limbs over one year since he was 15, was referred to our neurology clinic. Electro-diagnostic study revealed sensory and motor demyelinating polyneuropathy. He received intravenous immunoglobulin (IVIG) followed by corticosteroids as maintenance therapy and had an excellent response to therapy. At his recent presentation (2016), he revealed sudden onset horizontal diplopia and bilateral abduction deficit, which was consistent with bilateral sixth nerve palsy. Brain magnetic resonance imaging (MRI) was normal and lumbar puncture showed elevated protein with normal cell count.