Walsh & Hoyt: Clinical Manifestations

CIDP usually begins insidiously and may evolve very slowly. Unlike AIDP, it may take months for it to reach its maximum level of severity. The condition is characterized by symmetric proximal and distal weakness that occurs early in the illness. This progressively worsens over 6 weeks or more and is associated with hyporeflexia or areflexia. The weakness may be mild or severe, but assisted ventilation is rarely required. Most patients also develop sensory disturbances, particularly paresthesias in the toes and the tips of the fingers, although painful paresthesias are uncommon. In some patients, these and other sensory symptoms occur early in the course of the disease. In 10 patients with CIDP in whom there was electrophysiologic evidence of demyelination of both sensory and motor nerve fibers, the majority of clinical symptoms were sensory. Some patients with CIDP develop a postural tremor that is unrelated to weakness or proprioceptive loss and usually occurs late in the course of the disease.