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Polirradiculoneuropatia desmielinizante inflamatória crônica

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 18 Aug 2025
Last updated: 31 May 2023

Summary

Definition

History and exam

Key diagnostic factors

  • progressão da doença
  • fraqueza
  • alterações sensitivas
  • redução dos reflexos tendinosos profundos
Full details

Other diagnostic factors

  • falta de coordenação
  • idade entre 40 e 60 anos
  • infecção precedente
  • ausência de exposição a medicamentos que causam neuropatia
  • dispneia
  • fraqueza facial
  • disartria
  • disfagia
  • incontinência urinária
  • urgência ou hesitação urinária
  • impotência
  • hipotensão ortostática
  • papiledema
  • perda da visão
  • espasticidade
Full details

Risk factors

  • sexo masculino
  • doenças autoimunes
  • diabetes mellitus
  • infecção
  • gamopatia monoclonal de significado indeterminado (MGUS)
Full details

Diagnostic tests

1st tests to order

  • estudos da condução nervosa
Full details

Tests to consider

  • avaliação do líquido cefalorraquidiano (LCR)
  • ultrassonografia de nervo
  • RNM da coluna vertebral e do plexo com e sem contraste
  • protocolo clínico da terapia
  • biópsia de nervo
  • ensaio de imunoadsorção enzimática (ELISA) ou Western blot para detectar autoanticorpos
  • outros testes
Full details

Treatment algorithm

ACUTE

sem impacto significativo sobre o funcionamento e a qualidade de vida

impacto significativo sobre o funcionamento e a qualidade de vida

resposta parcial ou ausente à monoterapia inicial

refratário à terapia combinada com 2 agentes iniciais

ONGOING

resposta ao tratamento

ausência de resposta ao tratamento

Contributors

Authors

Karissa L. Gable, MD

Associate Professor of Neurology

Department of Neurology

Duke University School of Medicine

Durham

NC

Disclosures

KLG has taken part in CIDP education events for Medscape/Web MD. KLG is an author of references cited in this topic.

Thapat Wannarong, MD

Fellow of Neurology

Department of Neurology

Duke University School of Medicine

Durham

NC

利益声明

TW is an author of references cited in this topic.

鸣谢

Dr Karissa L. Gable and Dr Thapat Wannarong would like to gratefully acknowledge Professor Glenn Lopate, the previous contributor to this topic.

利益声明

GL is on the medical advisory board for Alnylam Pharmaceuticals and a consultant for Gerson Lehrman Group. GL is an author of references cited in this topic.

同行评议者

Anza B. Memon, MD

Senior Staff Neurologist

Henry Ford Health System

Clinical Assistant Professor

Wayne State University School of Medicine

Detroit

MI

利益声明

ABM declares that she has no competing interests.

Richard A.C. Hughes, MD, FRCP, FMedSci

Professor

Cochrane Neuromuscular Disease Group

MRC Centre for Neuromuscular Disease

National Hospital for Neurology and Neurosurgery

London

UK

利益声明

RACH has held or holds consultancies with companies that produce intravenous immunoglobulin (CSL Behring, LFB, Octapharma, Kedrion, and Talecris) and with other companies that produce immunomodulatory drugs (Biogen-Idec and Ares-Serono). RACH has received grants from the UK Department of Health for the Cochrane Neuromuscular Disease Review Group, Sandoz (now Novartis), and Ares-Serono. RACH is an author of a number of references cited in this topic.

Jean-Michel Vallat, MD

Professor

CHU Dupuytren

Service et Laboratoire de Neurologie

Limoges

France

利益声明

Not disclosed.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Van den Bergh PYK, van Doorn PA, Hadden RDM, et al. European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force - second revision. Eur J Neurol. 2021 Nov;28(11):3556-83.全文  摘要

Dyck PJB, Tracy JA. History, diagnosis, and management of chronic inflammatory demyelinating polyradiculoneuropathy. Mayo Clin Proc. 2018 Jun;93(6):777-93.全文  摘要

Broers MC, Bunschoten C, Drenthen J, et al. Misdiagnosis and diagnostic pitfalls of chronic inflammatory demyelinating polyradiculoneuropathy. Eur J Neurol. 2021 Jun;28(6):2065-73.全文  摘要

Oaklander AL, Lunn MP, Hughes RA, et al. Treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): an overview of systematic reviews. Cochrane Database Syst Rev. 2017 Jan 13;(1):CD010369.全文  摘要

Mahdi-Rogers M, Brassington R, Gunn AA, et al. Immunomodulatory treatment other than corticosteroids, immunoglobulin and plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Database Syst Rev. 2017 May 8;(5):CD003280.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • 鉴别诊断

    • Síndrome de Guillain-Barré (GBS)
    • Doença de Charcot-Marie-Tooth (CMT)
    • Neuropatia de antiglicoproteína associada à mielina (anti-MAG)
    更多 鉴别诊断

  • 指南

    • European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force - second revision
    更多 指南
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