Hypertrophic Peripheral Neuritis

Three months ago: Feeling of pins and needles in both feet; this rapidly spread up both legs to the knees. Legs got tired easily, feet felt heavy, and knees occasionally gave way with him. Two months ago: weakness of lower limbs was at its height. Had difficulty in walking without support. Fingers began to feel numb and clumsy; grip rather weak. For two weeks his vision became misty for near objects and he could not see to read properly. His voice grew husky and at times he seemed to be talking through his nose. No difficulty in chewing or swallowing; no nasal regurgitation. One month ago: Began to improve; improvement was rapid and is now almost complete subjectively. Now complains simply of some tingling in his toes, soreness and tenderness in calves and soles, and a little weakness of both lower limbs. No history of sore throat or diphtheria-contact. On examination.-Well-nourished, healthy-looking youth. Nose and throat healthy. Nasal and throat swabs negative for Klebs-Loffler bacillus. Schick reaction negative. Functions of all cranial nerves now normal. Slight weakness of both grips, extensors and flexors of wrists and fingers. Lower limbs: Slight symmetrical weakness of both anterior tibial groups, not of a degree to produce any functional disability now, except early fatigue. Small muscles of feet tender to pressure. Gait and stance normal. Tendon reflexes all absent. Abdominals present, plantars flexor. Sensation: slight hypo-algesia over terminal phalanges of fingers, and over lower limbs up to level of knees. Posterior-column sensibility intact. Cerebrospinal fluid clear, three cells, total protein-0 150%. Wassermann reaction negative in blood and cerebrospinal fluid.