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Diphtheritic Polyneuropathy
Clinical Analysis of Severe Forms
Michael A. Piradov, MD, PhD, DMSc;
Victor N. Pirogov, MD;
Lubov M. Popova, MD;
Irina A. Avdunina, MD
Arch Neurol. 2001;58:1438-1442.
Background Diphtheritic polyneuropathy (DP) is a dangerous complication of diphtheria,
especially its severe forms with bulbar, respiratory tract, and circulatory
disturbances. However, the clinical picture of severe forms of DP is practically
unknown.
Objective To investigate the clinical features and peculiarities of the course
of severe forms of DP.
Patients Thirty-two patients with severe forms of DP.
Results The first symptoms of DP developed in most patients 3 to 5 weeks after
the onset of diphtheria. The cranial nerves were involved in all patients,
most frequently nerves IX and X (32 patients); VII (28 patients); III, IV,
and VI (27 patients); and XI (27 patients). One third of the patients had
quadriplegia. The remaining patients had quadripareses. Of the 32 patients,
24 underwent artificial ventilation. All patients had sensory signs, proprioceptive
more often than superficial. Autonomic disturbances were observed also in
all patients. Only 2 of the 32 patients died.
Conclusions A direct indication for tracheotomy and artificial ventilation in patients
with DP is a decrease of the vital capacity of the lungs below the traditional
16 mL/kg body weight or the development of the paralytic closure of the larynx
against the background of the increasing weakness of the respiratory muscles.
Characteristic of severe forms of DP is the phenomenon of the oppositely directed
change in the neurological symptoms in the second month of the disease: the
restoration of the function of the cranial nerves against the background of
the further increase of the motor disturbances in the extremities and trunk.
Special attention and care should be taken of patients during the period of
the appearance of the episodes of vascular collapses—between the fourth
and seventh weeks of DP.
From the Neurointensive Care Department, Institute of Neurology, Russian
Academy of Medical Sciences, Moscow.
Corresponding author and reprints: Michael A. Piradov, MD, PhD, DMSc,
Institute of Neurology, Russian Academy of Medical Sciences, Volokolamskoye
Shosse 80, 123367 Moscow, Russia (e-mail: mpiradov{at}neurology.med.ru).
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