| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (MM) Class of 2023, Baylor College of Medicine, Houston, Texas |
| Transcript |
Today we're going to be talking about AIDP and CIDP as they relate to neuro-ophthalmology. And AIDP is an acute inflammatory demyelinating polyneuropathy, and that is A (acute), I (inflammatory), D (demyelinating), P (polyneuropathy). And CIDP is the same thing except it's chronic. So we've got an acute and a chronic demyelinating polyneuropathy, and the AIDP version you might know better as Guillain-Barré. So Guillain-Barré syndrome is an acute inflammatory demyelinating polyneuropathy. It's characterized by an ascending polyneuropathy, which is going to be weakness and sensory deficits, usually in lower extremities and then coming upward. It's going to have albumin ocytologic dissociation, which is a fancy way of saying that you have an elevated CSF protein but a normal CSF white count. And we're going to have antibodies, which is the GQ1B,which is molecular mimicry, cross reaction with the lipo oligosac charideon the campylobacter, but any of a number of infections can cause it and a number of ganglioside antibodies can be associated with this. And you may or may not have the other features, which is the are flexia and the ataxia forms. So it's all a's: an ascending polyneuropathy, albumin ocytologic dissociation, antibodies to GQ1B, are flexia with or without ataxia. This is the Guillain-Barré syndrome. If you add in the ophthalmoplegia, which is the diplopia, or the other eye findings-ptosis, pupil involvement sometimes-that's called Miller Fisher syndrome. The chronic form is chronic and progressive. It has no eponym, so it's like chronic Guillain-Barré syndrome. The chronic form can come to me because it canal so produce ophthalmoplegia. It has no eponym in the chronic form, and it can cause optic neuropathy and vision loss, which is the central form. The central form of the anti-GQ1Bdisorders is called Bickerstaff, Bickertaff brainstem encephalitis. So we have a spectrum from peripheral nervous system all the way to central nervous system. In the peripheral forms, that's Guillain-Barré and Miller-Fisher syndrome, and in the central forms, that's the Bickerstaff. And so you need to know a little bit about both acute and chronic inflammatory demyelinating polyneuropathies. EMG scan show the inflammatory demyelinating polyneuropathy, but generally it's a clinical diagnosis supported by the laboratory studies, and as with Guillain-Barré, we're going to be treating with IVIg or plasma exchange. In the chronic form we're also going to be using IVIg or plasma exchange. The main thing is AIDP and CIDP are pretty much the same thing except one's acute and the other is chronic. And AIDP has all these eponyms, AIDP regular form-Guillain-Barré syndrome, ophthalmoplegia form-Miller-Fisher syndrome, brain stem form, encephalitis -Bickerstaff brainstem encephalitis. All of these are anti-ganglioside related inflammatory demyelinating polyneuropathies, and in the chronic form, CIDP we have no names. We have no names for the ophthalmoplegia version, we have no names from the optic neuropathy version, we have no name for the regular version. So we just call that CIDP. And you need to know a little bit about AIDP before you can understand CIDP. |
