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Clinical Features of Lewis–Sumner Syndrome: Can Trauma Precipitate Symptoms?

  • Isaac Michael William Hughes (a1) and Alan Edward Goodridge (a2)

Abstract:

Introduction: Lewis–Sumner syndrome (LSS) is a demyelinating peripheral neuropathy described in 1982. Methods: We reviewed the charts of nine LSS patients in neurological care for their symptoms, response to different treatment regimens, and pattern of nerve involvement. Results: One patient had an Adie’s pupil. Every patient studied had median nerve involvement. Seven of nine patients required intravenous immunoglobulin (IVIg) therapy and all showed improvement with IVIg. Four of nine patients received oral steroid therapy and had some improvement. Two of nine patients received azathioprine to little effect. Two of nine patients experienced significant trauma while receiving neurological follow-up and their symptoms worsened to a clinically significant degree afterward. Discussion: We noticed a possible association between trauma and symptom severity in cases of LSS with preexisting neurological follow-up. We hypothesize that physical trauma exacerbates LSS. To our knowledge, this is an unreported phenomenon.

Est-il possible qu’un traumatisme déclenche l’apparition de symptômes liés au syndrome de Lewis-Sumner? Introduction: Le syndrome de Lewis-Sumner (SLS) est une neuropathie périphérique démyélinisante qui a été décrite en 1982. Méthodes: Nous avons passé en revue les dossiers de 9 patients atteints du SLS et bénéficiant de soins neurologiques visant à soulager leurs symptômes. Nous nous sommes aussi penchés sur leurs réponses à divers régimes de traitement et sur les niveaux d’atteinte de la conduction nerveuse. Résultats: Si l’ensemble des patients ont vu leur nerf médian être atteint, mentionnons qu’un seul d’entre eux a été atteint de pupille tonique d’Adie. Soulignons aussi que sept patients ont eu besoin d’une thérapie d’immunoglobulines administrées par voie intraveineuse (IgIV). Tous ont alors montré des signes d’amélioration. Quatre patients sur neuf se sont vu administrer des stéroïdes par voie orale. On a alors noté chez eux une certaine amélioration. Deux patients ont également bénéficié d’azathioprine, ce qui a entraîné peu d’effet chez eux. Enfin, deux autres patients ont subi de graves traumatismes durant leur période de suivi neurologique. D’un point de vue clinique, leurs symptômes se sont par la suite aggravés de manière notable. Discussion: Nous avons ainsi observé un lien potentiel entre des traumatismes et la gravité des symptômes de patients atteints du SLS bénéficiant d’un suivi neurologique. Nous émettons l’hypothèse que les traumatismes physiques peuvent exacerber les manifestations du SLS, ce qui, à notre connaissance, constitue un phénomène clinique n’ayant jamais été signalé.

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Corresponding author

Correspondence to: Isaac Michael William Hughes, Department of Medicine, Division of Neurology, Dalhousie University, 222–2080 Quingate Place, Halifax, NS, Canada B3L 4R9. Email: mwihughes@gmail.com

References

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