Improving Acute Motor and Sensory Axonal Neuropathy Outcomes Through Early Rehabilitation and Therapy

Case Diagnosis: This case highlights a significant and rapid improvement in an AMSAN patient, highlighting the effectiveness of our treatment.

Case Description or Program Description: A healthy, athletic 38-year-old female with no past medical history presented with dyspnea, edema, progressive paresthesias, and weakness following a mononucleosis infection in Mexico. She received IVIG for four days, with worsening symptoms, prompting a switch to plasma exchange (5 sessions) and a 3-day pulse steroid course followed by 40 mg steroids twice daily. MRI showed diffuse nerve root enhancement, and CSF analysis revealed albuminocytologic dissociation. Neuromuscular EMG confirmed AMSAN.

Setting: This report took place at Palomar Health Rehabilitation Institute.

Assessment/Results: Upon IRF admission, she was dependent on all ADLs but cognitively intact (A&Ox4) with maintained continence. At discharge, she showed significant improvement, requiring minimal assistance for eating and oral hygiene, partial to moderate help for toileting, bathing, and lower body dressing, while dressing her upper body independently. Discharged home with home health, she planned to transition to outpatient therapy.

Discussion (relevance): Our case demonstrates rapid recovery. Compared to a previously healthy 37-year-old male with AMSAN post-tonsillitis and gastroenteritis, our patient improved much faster. Despite IVIG and plasma exchange, the male patient required 84 hospitalization days (45 in ICU, 37 in ward) and showed delayed improvement only after pulse-steroid therapy, regaining lower limb strength (2/5 to 4+) and ambulating with assistance. In contrast, our patient achieved nearly 100% upper body recovery and 50-75% lower body improvement within three months. She was hospitalized for 14 days, followed by 91 days in rehabilitation. This suggests a multimodal strategy with steroids and early rehabilitation may accelerate recovery.

Conclusions: This rare AMSAN case presented atypically with cyanosis and visual disturbances. Despite severe deficits, intensive rehabilitation enabled significant functional gains and home discharge. Further research is needed to optimize multimodal treatment strategies for AMSAN.