AIDP or GBS is an ascending, usually demyelinating, motor > sensory polyneuropathy accompanied by areflexia, motor paralysis, and elevated CSF total protein without pleocytosis. Over two-thirds are preceded by an acute respiratory or gastrointestinal infection. Maximum weakness is usually reached within 2 weeks; demyelination by EMG. Most pts are hospitalized; one-third require ventilatory assistance. 85% make a complete or near-complete recovery with supportive care. Variants of GBS include Miller Fisher syndrome (ophthalmoparesis, facial diplegia, ataxia, areflexia; associated with serum antibodies to ganglioside GQ1b) and acute motor axonal neuropathy (more severe course than demyelinating GBS; antibodies to GM1 in some cases).
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a slowly progressive or relapsing polyneuropathy characterized by diffuse hyporeflexia or areflexia, diffuse weakness, elevated CSF protein without pleocytosis, and demyelination by EMG.
Diabetic neuropathy typically presents as a distal symmetric, sensorimotor, axonal polyneuropathy. A mixture of demyelination and axonal loss is frequent. Other variants include: isolated sixth or third cranial nerve palsies, asymmetric proximal motor neuropathy in the legs, truncal neuropathy, autonomic neuropathy, and an increased frequency of entrapment neuropathy (see below).
Mononeuropathy multiplex (MM) is defined as involvement of multiple individual peripheral nerves. When an inflammatory disorder is the cause, mononeuritis multiplex is the term used. Both systemic (67%) and nonsystemic (33%) vasculitis may present as MM. Immunosuppressive treatment of the underlying disease (usually with glucocorticoids and cyclophosphamide) is indicated. A tissue diagnosis of vasculitis should be obtained before initiating treatment; a positive biopsy helps to justify the necessary long-term treatment with immunosuppressive medications, and pathologic confirmation is difficult after treatment has commenced.