Delayed onset post-traumatic wound botulism.

A 41-year-old man developed rapidly progressive cranial neuropathies and muscle weakness followed by respiratory failure, requiring ventilation support. On examination, there was marked bilateral ptosis and ophthalmoplegia with bulbar, neck and proximal upper limb weakness. He had a recent open left humeral fracture that eventually required amputation. Despite immunoglobulin therapy, his progressive weakness continued. Multiple investigation results were inconclusive. Eventually, botulinum type A toxin was found positive, by which time the therapeutic window for antitoxin had passed. He continued on supportive management and was treated for concomitant infections and nosocomial illnesses. He was subsequently weaned from respiratory support and has made a good neurological recovery.

Prognosis and outcome in patients with chronic inflammatory demyelinating polyradiculoneuropathy in a tertiary center in Oman.

Background: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated condition with variable clinical characteristics and different treatment modalities. We aim to present different clinical and demographic features of all patients with CIDP presented to the neuromuscular clinic within four years and their follow-up results. Methods: A retrospective study from a hospital database of 23 patients met the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) diagnostic criteria for CIPD. Complete demographic and clinical data were collected. Progress and outcome were assessed using two clinical score systems at regular intervals at 6, 12, and 18 months. Results: Mean age of patients was 43.4 ± 20.9 years (male-to-female ratio was 1.6:1). Age of onset was 39.7 ± 18.0 years. At the presentation, the Medical Research Council sum score (MRCss) was 50 (39.7-51.3), and the modified Rankin Scale (mRS) was 3 (2.2-3.4). There was a significant improvement in MRCss during four periods (P < 0.001). Multiple comparisons revealed a significant difference in MRCss between the baseline and 12 and 18 months but no significant change between the baseline and 6 months. Likewise, mRS showed a significant improvement between the baseline and 18 months (no significant change between the baseline and 6 months or 12 months). Conclusion: The clinical characteristics of CIDP in our cohort were similar to other reported studies, and most of the studied patients had good outcomes. Our results could be utilized as baseline data for a better understanding of the characteristics of CIDP in Oman and, consequently, for better management of the disease.