Skip to main content

Spinal cord involvement in chronic inflammatory demyelinating polyradiculoneuropathy: a clinical and MRI study

Abstract

Concomitant central nervous system (CNS) involvement in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is rare. Although the spinal nerve roots may present MRI abnormalities in CIDP, hitherto, the spinal cord has been investigated in a single study. We retrospectively investigated clinically and with MRI a cohort of patients with definite CIDP diagnosis (EFNS/PNS criteria) for evidence of brain and spinal cord involvement, who were initially admitted in our department during the last 4 years. Among 12 patients with CIDP (men: 8, mean age: 59.3 years, mean disease duration: 3.8 years), nine patients had their MRI scan during a clinical relapse and three during remission. Brain MRI did not document typical multiple sclerosis lesions in any patient. We did not identify any MRI abnormalities in ten patients without clinical evidence of spinal cord involvement. Conversely, MRI disclosed extensive lesions of the thoracic cord in two patients with an overt spinal cord syndrome, whom we describe. This represents the biggest MRI study of CIDP patients who have been investigated for spinal cord involvement. Our data support earlier observations that a minority of CIDP patients may additionally develop CNS involvement of variable degree.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Hahn AF, Hartung H-P, Dyck PJ (2005) Chronic inflammatory demyelinating polyradiculoneuropathy. In: Dyck PJ, Thomas PK (eds) Peripheral Neuropathy, 4th edn. Elsevier Saunders, Philadelphia, pp 2221–2253

    Chapter  Google Scholar 

  2. Dyck PJ, Lais AC, Ohta M et al (1975) Chronic inflammatory polyradiculopathy. Mayo Clin Proc 50:621–637

    CAS  PubMed  Google Scholar 

  3. Mc Combe PA, Pollard JD, Mc Leod JG (1987) Chronic inflammatory demyelinating polyradiculoneuropathy. Brain 110:1617–1630

    Article  Google Scholar 

  4. Thomas PK, Walker RW, Rudge P, Morgan-Hughes JA, King RH, Jacobs JM, Mills KR, Ormerod IE, Murray NM, McDonald WI (1987) Chronic demyelinating peripheral neuropathy associated with multifocal central nervous system demyelination. Brain 110:53–76

    Article  PubMed  Google Scholar 

  5. Lassmann H, Budka H, Schnaberth G (1981) Inflammatory demyelinating polyradiculitis in a patient with multiple sclerosis. Arch Neurol 38:99–102

    Article  CAS  PubMed  Google Scholar 

  6. Ormerod IEC, Waddy HM, Kermode AG et al (1990) Involvement of the central nervous system in chronic inflammatory demyelinating polyneuropathy: a clinical, electrophysiological and magnetic resonance imaging study. J Neurol Neurosurg Psychiatry 53:789–793

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Stojkovic T, de Seze J, Hurtenvent JF et al (2000) Visual evoked potentials study in chronic idiopathic inflammatory demyelinating polyneuropathy. Clin Neurophys 111:2285–2291

    Article  CAS  Google Scholar 

  8. Feasby TE, Hahn AF, Koopman WJ et al (1990) Central lesions in chronic inflammatory demyelinating polyneuropathy: an MRI study. Neurology 40:476–478

    Article  CAS  PubMed  Google Scholar 

  9. Tanaka K, Mori N, Yokota Y, Suenaga T (2013) MRI of the cervical nerve roots in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy: a single-institution, retrospective case–control study. BMJ Open 3:e003443

    Article  PubMed Central  PubMed  Google Scholar 

  10. Laura M, Leong W, Murray NMF et al (2005) Chronic inflammatory demyelinating polyradiculoneuropathy: MRI study of brain and spinal cord. Neurology 64:914–916

    Article  CAS  PubMed  Google Scholar 

  11. Joint Task Force of the EFNS and the PNS European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy (2010) Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society–First Revision. Eur J Neurol 17:356–363

    Article  Google Scholar 

  12. Charil A, Yousry TA, Rovaris M, Barkhof F, De Stefano N, Fazekas F, Miller DH, Montalban X, Simon JH, Polman C, Filippi M (2006) MRI and the diagnosis of multiple sclerosis: expanding the concept of “no better explanation”. Lancet Neurol 5:841–852

    Article  PubMed  Google Scholar 

  13. Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C et al (2013) Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. standards for reporting vascular changes on neuroimaging (STRIVE v1). Lancet Neurol 12:822–838

    Article  PubMed Central  PubMed  Google Scholar 

  14. Zephir H, Stojkovic T, Latour P et al (2008) Relapsing demyelinating disease affecting both the central and peripheral nervous systems. J Neurol Neurosurg Psychiatry 79:1032–1039

    Article  CAS  PubMed  Google Scholar 

  15. Nagamuna M, Shima K, Matsumoto A et al (1991) Chronic multifocal demyelinating neuropathy associated with central nervous system demyelination. Muscle Nerve 14:953–959

    Article  Google Scholar 

  16. Lewis RA (2007) Neuropathies associated with conduction block. Curr Opin Neurol 20:525–530

    Article  PubMed  Google Scholar 

  17. Staff NP, Figueroa JJ, Parisi JE et al (2010) Hypertrophic nerves producing myelopathy in fulminant CIDP. Neurology 75:750

    Article  PubMed Central  PubMed  Google Scholar 

  18. Bouchard C, Lacroix C, Plante V et al (1999) Clinicopathologic findings and prognosis of chronic inflammatory demyelinating polyneuropathy. Neurology 52:498–503

    Article  CAS  PubMed  Google Scholar 

  19. Lewis RA, Sumner AJ, Brown MJ et al (1982) Multifocal demyelinating neuropathy with persistent conduction block. Neurology 32:958–964

    Article  CAS  PubMed  Google Scholar 

  20. Viala K, Renie L, Maisonobe T et al (2004) Follow-up study and response to treatment in 23 patients with Lewis-Sumner syndrome. Brain 127:2010–2017

    Article  CAS  PubMed  Google Scholar 

  21. Rezania K, Arnason B, Soliven B (2006) Patterns and significance of concomitant central and peripheral inflammatory demyelination. Neurol Res 28:326–333

    Article  PubMed  Google Scholar 

  22. Falcone M, Scalise A, Minisci C et al (2006) Spreading of autoimmunity from central to peripheral myelin: two cases of clinical association between multiple sclerosis and chronic inflammatory demyelinating polyneuropathy. Neurol Sci 27:58–62

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

Authors state that there is no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Panagiotis Ioannidis.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ioannidis, P., Parissis, D., Karapanayiotides, T. et al. Spinal cord involvement in chronic inflammatory demyelinating polyradiculoneuropathy: a clinical and MRI study. Acta Neurol Belg 115, 141–145 (2015). https://doi.org/10.1007/s13760-014-0323-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13760-014-0323-x

Keywords

  • CIDP
  • CNS involvement
  • Demyelination