Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP)-MRI
Clinical history: 36 year old female. Neck pain, radiating to left side. No other constitutional symptoms.
Provisional MR diagnosis: CIDP under evaluation
Teaching points by Dr MGK Murthy, Dr Praveen Jha
1. Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP) is a treatable, relapsing,immune mediated disorder and is a fashionable terminology amongst the radiologists using MR Neurography. Clinically presents with peripheral sensory neural deficits with NCVs suggesting acquired demyelinating polyneuropathy and EMGs showing Active denervation with Laboratory including CSF unhelpful
2. MRI/Neurography usually shows symmetrical high signal on STIR and enlargement of brachial plexus. Symmetricality with High signal intensity of nerve roots and beyond ( Ref- sternocleidomastoid muscle signal) is more a reliable sign as compared to increased diameter and thickening of brachial plexus as such (European Federation for Neurological Diseases (EFND) criterion for probable/ definite CIDP refers)
3. Steroids and Intravenous Immunoglobulins form the mainstay for therapy. Though many believe MR findings persist even after symptoms improve and hence should not be used for Prognostication, some believe persistence of findings may suggest refractoriness to immunomodulation. .Long term (of decades) follow up shows secondary axonal degeneration , leading to MRI pictures suggesting Atrophy
4. MRI findings can not differentiate the Clincial mimics of CIDP including MMN (multifocal motor neuropahty) which shows asymmetry and no sensory loss on clinical examination .
Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP)-MRI Reviewed by Sumer Sethi on Monday, December 08, 2014 Rating: