Lewis Sumner Syndrome with focal muscle hypertrophy and central demyelination

A 45year old patient presented with upper and lower motor neurone abnormalities. A diagnosis of Lewis Sumner Syndrome was made on the basis of asymmetric multifocal motor and sensory loss, conduction block and thickened brachial plexus on MRI. Rarely peripheral nerve demyelinating diseases may be accompanied by demyelination in the central nervous system causing diagnostic confusion. This case illustrates the pitfalls of diagnosing this rare condition and highlights its rare manifestations. We also stress the importance of electrophysiology in diagnosing this very treatable inflammatory neuropathy and discuss the usefulness of imaging as additional diagnostic aid.

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