I want to share this my recent experience. This 62 yr old male who has been known Addison's disease on maintenance dose of steroids was referred by my teacher for evaluation of numbness of hands and feet probably GBS. On examination he had evidence of glove and stocking type of hypoesthesia. Joint and vibratory sense loss were more pronounced. Jerks were down and plantars were extensors. Gait normal and Romberg was positive. No recent weight loss or cough or appetite loss. He had recently retired from a textile industry as the chief where he had been exposed to dyes whose chemical nature unknown.
EDX showed a polyneuropathy more marked in lower limbs. EMG normal. Routine blood tests including a mini GTT were normal. Peripheral smear showed oval macrocytes. CXRPA - normal.
I made a clinical diagnosis of either toxic polyneuropathy or a combined degeneration. His blood B12 and folate levels were asked for. Blood cortisol level was low and daily maintenance dose was increased with solumedrol infusion 1 gm/day was given with B12 and folate replacement. MRI is more or less classical which I had requested Dr Michael to put on the web site. What do you feel ?
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Revised February 12, 2001
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