Abstract
An account is given of four patients with acute idiopathic polyneuritis, leading within a few days to almost total paralysis. Two of these (cases 3 and 4) began to recover voluntary movement in the limbs in a month or less, and showed complete clinical recovery in three and 10 months respectively. The other two (cases 1 and 2) began to recover proximal limb movements after three months, reached a plateau of recovery in about two years, and never recovered movements in the distal parts of the limbs, which underwent muscular atrophy. Patient 2 died 14 years after the acute illness and was examined post mortem. The difference in recovery is explained by supposing that in patients 3 and 4 the lesions consisted predominantly of segmental demyelination, whereas in patients 1 and 2 there was extensive axon destruction at a proximal level. Recovery in the latter depended upon nerve regeneration, which restored the power of the proximal muscles, but was too slow for effective reinnervation of distal muscles. This explanation is supported by post mortem findings in patient 2. A further observation in patient 2 was of degeneration of the posterior white columns of the spinal cord, which was not due to loss of posterior root fibres. It is believed that in such cases a prognosis as to ultimate recovery of muscle power can be made about a month after the acute phase, according to whether movement has begun to return in the distal parts of the limbs. If recovery does not occur within two years it will not occur at all.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Asbury A. K., Arnason B. G., Adams R. D. The inflammatory lesion in idiopathic polyneuritis. Its role in pathogenesis. Medicine (Baltimore) 1969 May;48(3):173–215. doi: 10.1097/00005792-196905000-00001. [DOI] [PubMed] [Google Scholar]
- Caspary E. A., Currie S., Walton J. N., Field E. J. Lymphocyte sensitization to nervous tissues and muscle in patients with the Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. 1971 Apr;34(2):179–181. doi: 10.1136/jnnp.34.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gutmann E., Young J. Z. The re-innervation of muscle after various periods of atrophy. J Anat. 1944 Jan;78(Pt 1-2):15–43. [PMC free article] [PubMed] [Google Scholar]
- Hall J. I. Studies on demyelinated peripheral nerves in guinea-pigs with experimental allergic neuritis. A histological and electrophysiological study. II. Electrophysiological observations. Brain. 1967 Jun;90(2):313–332. doi: 10.1093/brain/90.2.313. [DOI] [PubMed] [Google Scholar]
- Hewer R. L., Hilton P. J., Smith A. C., Spalding J. M. Acute polyneuritis requiring artificial respiration. Q J Med. 1968 Jul;37(147):479–491. [PubMed] [Google Scholar]
- McQuillen M. P. Idiopathic polyneuritis: serial studies of nerve and immune functions. J Neurol Neurosurg Psychiatry. 1971 Oct;34(5):607–615. doi: 10.1136/jnnp.34.5.607. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morgan-Hughes J. A. Experimental diphtheritic neuropathy. A pathological and electrophysiological study. J Neurol Sci. 1968 Jul-Aug;7(1):157–175. doi: 10.1016/0022-510x(68)90011-7. [DOI] [PubMed] [Google Scholar]
- Pleasure D. E., Lovelace R. E., Duvoisin R. C. The prognosis of acute polyradiculoneuritis. Neurology. 1968 Dec;18(12):1143–1148. doi: 10.1212/wnl.18.12.1143. [DOI] [PubMed] [Google Scholar]
- WAKSMAN B. H., ADAMS R. D. A comparative study of experimental allergic neuritis in the rabbit, guinea pig, and mouse. J Neuropathol Exp Neurol. 1956 Jul;15(3):293–334. doi: 10.1097/00005072-195607000-00005. [DOI] [PubMed] [Google Scholar]
- WAKSMAN B. H., ADAMS R. D. Allergic neuritis: an experimental disease of rabbits induced by the injection of peripheral nervous tissue and adjuvants. J Exp Med. 1955 Aug 1;102(2):213–236. doi: 10.1084/jem.102.2.213. [DOI] [PMC free article] [PubMed] [Google Scholar]
- WOHLFART G. Collateral regeneration from residual motor nerve fibers in amyotrophic lateral sclerosis. Neurology. 1957 Feb;7(2):124–134. doi: 10.1212/wnl.7.2.124. [DOI] [PubMed] [Google Scholar]
- WOHLFART G. Collateral regeneration in partially denervated muscles. Neurology. 1958 Mar;8(3):175–180. doi: 10.1212/wnl.8.3.175. [DOI] [PubMed] [Google Scholar]