Polyneuritis cranialis with generalized hyperreflexia as a presenting manifestation of thyrotoxicosis

A 22-year-old male student with no past medical illness, presented with acute onset dysarthria, binocular diplopia, and dysphagia over 10 hours. On examination, he had tachycardia, hypertension, generalized hyper-reflexia, and bilateral pupil sparing oculomotor, troclear, abducens, trigeminal, facia...

Full description

Saved in:
Bibliographic Details
Published inAnnals of the Indian Academy of Neurology Vol. 18; no. 2; pp. 240 - 242
Main Authors Kasundra, Gaurav M, Bhargava, Amita Narendra, Bhushan, Bharat, Shubhakaran, Khichar, Sood, Isha
Format Journal Article
LanguageEnglish
Published India Medknow Publications and Media Pvt. Ltd 01.04.2015
Medknow Publications & Media Pvt. Ltd
Medknow Publications & Media Pvt Ltd
Wolters Kluwer Medknow Publications
Subjects
Abnormal reflexes
Bulbar palsy
Case Report
Case studies
dysphagia
Nervous system diseases
neuropathy
polyneuritis cranialis
Thyroid diseases
thyrotoxicosis
India
polyneuritis cranialis
dysphagia
neuropathy
thyrotoxicosis
Bulbar palsy
Online AccessGet full text

Cover

More Information
Summary:A 22-year-old male student with no past medical illness, presented with acute onset dysarthria, binocular diplopia, and dysphagia over 10 hours. On examination, he had tachycardia, hypertension, generalized hyper-reflexia, and bilateral pupil sparing oculomotor, troclear, abducens, trigeminal, facial, glossopharyngeal, and vagus nerve palsy. Rest examination was unremarkable. Facial nerve conduction study (NCS) showed decreased amplitude bilaterally and neurogenic pattern on electromyography. Limb NCS, repetitive nerve stimulation, neostigmine test, brain magnetic resonance imaging, cerebrospinal fluid, and biochemical tests were normal. Only positive tests were low thyroid-stimulating hormone (TSH) (<0.01), high free T3 (19.2 pmol/L), and high free T4 (39.2 pmol/L). Thyroid ultrasonography, anti-thyroid peroxidase, and anti-thyroglobulin antibody were normal. Patient was treated with anti-thyroid drugs, with which he completely recovered in 2 months. Though many cases with thyrotoxic myopathy have been reported, only few mention neuropathic cause of dysphagia or polyneuritis cranialis. Getting done thyroid function tests may be helpful in patients with polyneuritis cranialis of uncertain etiology.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0972-2327
1998-3549
DOI:10.4103/0972-2327.150625