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Basedow paraplegia: A possible misnomer.

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    Area of Science:

    • Neurology
    • Endocrinology

    Background:

    • Thyrotoxic myopathy is common in hyperthyroidism.
    • The association between hyperthyroidism and flaccid, areflexic paraplegia (Basedow paraplegia) is debated.
    • Graves' disease is a common cause of hyperthyroidism.

    Purpose of the Study:

    • To investigate a rare case of acute flaccid paraplegia in a patient with undiagnosed Graves' disease.
    • To explore the potential causative link between hyperthyroidism and paraplegia.
    • To differentiate this presentation from other neurological disorders.

    Main Methods:

    • Case report of an 18-year-old female with Graves' disease presenting with acute global weakness.
    • Clinical examination, laboratory tests (thyroid function, antibodies), and cerebrospinal fluid analysis.
    • Electroneuronography and needle electromyography to assess nerve and muscle function.
    • Treatment with intravenous immunoglobulin, carbimazole, and propranolol.

    Main Results:

    • The patient presented with severe hypotonia and areflexia, predominantly in the lower limbs.
    • Laboratory results confirmed hyperthyroidism and positive thyroid-stimulating hormone receptor antibodies.
    • Nerve conduction studies indicated an acute motor axonal neuropathy, consistent with a Guillain-Barre syndrome variant.
    • The patient responded to treatment for both hyperthyroidism and the neurological condition.

    Conclusions:

    • The presentation of flaccid, areflexic paraplegia in the context of hyperthyroidism may be coincidental rather than directly caused by the thyroid condition.
    • Acute idiopathic polyneuritis (Guillain-Barre syndrome) should be strongly considered in such cases.
    • Prompt diagnosis and management of both hyperthyroidism and the neurological deficit are crucial.