Chronic inflammatory demyelinating polyradiculoneuropathy: in a remote northern Ontario hospital.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired demyelinating syndrome that targets myelin sheaths of the peripheral nervous system. The course might be relapsing or steady, or follow a stepwise progression, with most younger individuals presenting with the relapsing course and older individuals presenting with the progressive course.1 It is more common in men, and usually presents with symmetric, gradually increasing weakness of the legs and, to a lesser extent, the arms. Based on pathologic findings and response to immune-modulating therapy, CIDP is believed to have an autoimmune pathogenesis.2 However, both cellular and humoural immunity have been implicated. It is closely related to Guillain-Barré syndrome; it is considered the chronic counterpart of this acute disease but is rarely preceded by an infection.3 Chronic inflammatory demyelinating polyradiculoneuropathy is considered the peripheral counterpart of multiple sclerosis because of similarities between the 2 diseases: presence of focal demyelination and coexistent axon damage, immune-mediated pathophysiology, and relapsing or progressive disease course.4 The prevalence of CIDP is reported to be from 1 to 7.7 per 100 000 people,5 but it is often underrecognized owing to its varied presentation and the limitations of clinical, serologic, and electrophysiologic diagnostic criteria. Despite these limitations, awareness and early diagnosis by primary care physicians who can facilitate treatment is important in preventing irreversible axonal loss and improving functional recovery.