Ocular palsy preceding chronic relapsing polyneuropathy by several weeks.

Area of Science:

• Neurology
• Neuroimmunology

Background:

• Chronic relapsing polyneuritis (CR P) can present with diverse neurological deficits.
• Understanding atypical presentations is crucial for accurate diagnosis and management.

Observation:

• Three patients presented with an unusual variant of chronic relapsing polyneuritis.
• Extraocular muscle palsies preceded limb neuropathy by weeks to months.
• Symptoms included dysphagia, areflexia, sensory loss, and limb weakness.

Findings:

• Peripheral neuropathy evolved over 7-12 weeks and relapsed in all cases.
• Electrophysiological studies showed slowed motor nerve conduction and prolonged F wave latencies.
• Cerebrospinal fluid analysis revealed elevated protein without pleocytosis.

Implications:

• This variant highlights the varied clinical manifestations of chronic relapsing polyneuritis.
• Early recognition of preceding extraocular palsies may aid in timely diagnosis.
• Prognosis remains guarded, with incomplete recovery even after immunosuppressive therapy.