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Multifocal Motor Neuropathy With Cranial Nerve Involvement and Vocal Cord Paralysis: A Case Report
Maria Clarissa Nunez1, Belinda Lioba M Nepomuceno2, Ma Luisa Gwenn P Tiongson2
1Department of Clinical Neurosciences, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, PHL.
Cureus
|June 24, 2022
Summary
Multifocal motor neuropathy (MMN) can affect cranial nerves, causing symptoms like vocal cord paralysis. This case highlights MMN with multiple lower cranial nerve involvements, successfully treated with Intravenous Immunoglobulin (IVIg).
Area of Science:
- Neurology
- Clinical Electrophysiology
Background:
- Multifocal motor neuropathy (MMN) is characterized by progressive, multifocal weakness, primarily in the upper extremities, without sensory deficits.
- A key electrophysiologic finding in MMN is the presence of conduction block.
Observation:
- A case report details an adult male with MMN presenting with cranial nerve involvement and vocal cord paralysis.
- The patient exhibited left shoulder weakness, hoarseness, tongue deviation, and muscle wasting, alongside electrophysiologic evidence of conduction blocks and involvement of the spinal accessory and hypoglossal nerves.
Findings:
- Laryngeal electromyography confirmed a focal mononeuropathy of the left recurrent laryngeal nerve.
- Nerve conduction studies revealed multifocal motor neuropathy with bilateral proximal conduction blocks in the median and ulnar nerves.
Implications:
- This case expands the known spectrum of MMN by documenting multiple lower cranial nerve involvement.
- The successful treatment with Intravenous Immunoglobulin (IVIg) underscores its efficacy in managing complex MMN presentations.
- This report contributes to the limited literature on MMN involving cranial nerves, emphasizing the need for comprehensive electrophysiologic assessment.
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