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Neurological Sciences
Published in: Neurological Sciences 8/2019

01-08-2019 | Guillain-Barré Syndrome | Brief Communication

Tonic pupils: an unusual autonomic involvement in chronic inflammatory demyelinating polyneuropathy (CIDP)

Authors: Marcio Luiz Escorcio-Bezerra, Gilberto Mastrocola Manzano, Denis Bernardi Bichuetti, Karlo Faria Nunes, Daniele Sales Alves Correa, Acary Souza Bulle Oliveira, Alex Machado Baeta

Published in: Neurological Sciences | Issue 8/2019

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Abstract

Background

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neuropathy which affects mainly large myelinated axons and has a typically mild autonomic dysfunction mainly from postganglionic nerve fiber involvement.

Case report

We report here an acute onset CIDP initially diagnosed as Guillain-Barré syndrome (GBS), unresponsive to treatment with intravenous immunoglobulin (IVIg), which later responded to plasmapheresis and corticoids. The patient had a markedly distal demyelination, prominent cranial nerve involvement and, interestingly, bilateral fixed dilated pupils. Despite complete clinical recovery, this neurological sign remained.

Conclusions

Tonic pupils have previously been described in different neurologic conditions, including GBS, but not yet in acute onset CIDP or in variants with predominantly distal demyelination. It differs from the classical Adie’s pupil because it lacks the light-near dissociation. This case report expands the range of possible autonomic signs in acute onset CIDP, which could help physicians establish optimal treatment strategies earlier on.
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Metadata
Title
Tonic pupils: an unusual autonomic involvement in chronic inflammatory demyelinating polyneuropathy (CIDP)
Authors
Marcio Luiz Escorcio-Bezerra
Gilberto Mastrocola Manzano
Denis Bernardi Bichuetti
Karlo Faria Nunes
Daniele Sales Alves Correa
Acary Souza Bulle Oliveira
Alex Machado Baeta
Publication date
01-08-2019
Publisher
Springer International Publishing
Published in
Neurological Sciences / Issue 8/2019
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-019-03890-8

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