Neurology and Neuroscience

Biography:

 Dr Sondos Eladawi MBBCh, MRCP (UK) , is a third-year internal medical trainee within the West midlands Deanery, United Kingdom. She is currently working withing the General medical department in Walsall Manor hospital. Dr Eladawi has a strong passion for Neurology. She has special interest in disorders of peripheral nerves, Motor Neuron Disease and Epilepsy.

Abstract:

Acute Motor Sensory Axonal Neuropathy (AMSAN) is a rare subtype of Guillain-Barré syndrome (GBS), which is an autoimmune disorder that affects the peripheral nervous system. In AMSAN, the immune system attacks the axons of the peripheral nerves, resulting in damage to both the motor and sensory nerves. This leads to muscle weakness, loss of reflexes, and sensory disturbances. Diagnosis of AMSAN is based on a combination of clinical symptoms and nerve conduction studies which help to distinguish AMSAN from other subtypes of GBS.

The case we present is a unique case of a twenty-four-year-old female who presented to the emergency department with abdominal pain and vomiting. She had a past medical history of Anxiety, depression, polycystic ovary syndrome and cannabis abuse. She was a current smoker but denied excessive alcohol intake.  Six days into admission she was found to have pins and needs in her lower limbs which then progressed to total loss of motor and sensory function in the upper and lower limbs within two weeks’ time. Few days later patient developed bilateral ophthalmoparesis, nystagmus and increased confusion.  Differential diagnosis considered were Wernicke’s encephalopathy, Miller fisher syndrome, Neuromyelitis optica spectrum disorder and Central pontine myelinolysis. Laboratory tests were unremarkable apart from mildly deranged liver function tests. She had Magnetic resonant Imaging (MRI) of the brain and whole spine done which were unremarkable as well. However, nerve conduction study findings were in keeping with AMSAN. She was started on intravenous immunoglobulins (IVIG) and pabrinex to cover for possible overlapping Wernicke’s encephalopathy. She then started to improve slowly following the completion of the treatment course and was discharged to rehabilitation centre for recovery.

The key for improvement of the long-term outcomes after the acute phase of AMSAN is early initiation of treatment which necessitates early recognition of the disease pattern.