Q. Why does paresthesia progress in post-polio syndrome?

Answered by
Dr. Rajyaguru
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 03, 2016 and last reviewed on: Oct 12, 2020

Hi doctor,

The patient is a 50 year old woman with a history of polio in childhood and complains of paresthesia since a year. It started suddenly from the toes on both sides and it progressed to upper back (T4) in 20 days. She was hospitalized with post-polio syndrome and treated with IV Ig. She complained of bilateral tinnitus and seeing some flash of light in central vision after IV Ig therapy. She had paresthesia of fingers and both hands after two months. She was hospitalized again and treated. She lost left leg movement during hospitalization, which progressed to hemiplegia. She denies any trauma, fever or incontinence. Her medication includes Gabapentin, Vitamin D and B1, Duloxetine and Chlordiazepoxide. Past medical history includes polio and migraine. Family history includes father with Alzheimer's, mother with HTN and heart failure. She is married, monogamous with husband and adopted one child. On physical examination, pupil was normal and no nystagmus. Laboratory tests showed CBC and differential nil, ESR 40, CRP 25. Also, I have attached her MRI report.

#

Hi,

Welcome to icliniq.com.

  • I do not quite agree with post-polio syndrome. Post-polio syndrome after these many years is quite rare.
  • From a neurosurgical point of view, when I look at her MRI cervical spine (attachment removed to protect patient identity), there is a significant disc bulge present at C5-C6. There is compression from both anterior and posterior sides.
  • Collective dynamic compression would be quite significant. This can explain her progressive symptoms even after IV Ig (intravenous immunoglobulin).
  • Please repeat MRI cervical spine with T2 sagittal images in 30 degrees of flexion and extension. Also, get NCV (nerve conduction velocity) in all four limbs and SSEP (somatosensory evoked potential) studies for a clear diagnosis.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist


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