A boy who was born on the seventh of November, 2009, and was first seen on 29th of January, 2018 at the Children Teaching Hospital of Baghdad Medical City and had Charcot Marie Tooth disease was observed. He had difficulty in walking and abnormal gait that made him left first grade primary school.

The parents were relatives and the boy had a healthy older sister aged eleven years who was doing well at fourth grade of primary school, and two younger sisters; one aged seven years and had the same illness. The youngest sister has early symptoms of the disorder, but her condition has not been evaluated yet.

In this case, the affection of a brother and sister suggests an autosomal recessive form of the disorder.

The boy was considered normal until the age of two, but the parents thought that after the age of two the boy was rather clumsy and falling things from hands. Weakness of the lower and upper limbs progressed slowly, and his gait gradually deteriorated. CT scan of the brain was performed on the first of April, 2013 and showed normal findings.

Creatine phosphokinase was 183 u/L which is little above the upper limit as the normal range is 38-174 u/L.

When the boy was examined, he was cooperative and can walk with difficulty (Figure 1). He was unable to stand up when sitting on the ground or from the squat position without holding the nearby chair.

He had weakness of the upper and lower limbs with diminished tendon reflexes and also had impairment of touch sensations on the lower and upper limbs suggesting polyneuropathy.

He was glad when asked to write something (Figure 1). He started writing despite having difficulty in holding the pen. He tried to draw a circle and an easy word, but he couldn’t draw a straight line (Figure 2).

Nerve conduction study was performed on the right and left median nerves, right and left ulnar nerves, right and left sural nerves and right and left common peroneal nerves by surface and needle electrodes.

1. Dispersed sensory response with prolonged distal sensory latencies with reduced amplitude and conduction velocities.

2. Prolonged distal motor latencies, lower border and reduced motor conduction velocities with prolonged F wave latencies.

3. Reduced amplitude of compound motor action potentials, on proximal and distal stimulation sites.

4. There was no evidence of conduction block.

1. Spontaeous activity grade 1.

2. Increased mean duration, amplitude, duration, and percentage of polyphasia.

3. Thirty to forty percent polyphasia of long duration and high amplitude.

4. Reduced recruitment pattern of high amplitude.

The nerve conduction study and electromyography study supported the clinical diagnosis of chronic symmetric sensori-motor polyneuropathy of moderated severity.

The uniform involvement, absence of conduction block, and the degree ofconduction slowing in conjunction with electromyography study suggestedthe diagnosis of type II hereditary sensory neuropathy which is consistentwith familial pattern observed in the patient and his sister.

The boy was treated with a safe novel therapy for one month. He receivedten doses of 3 ml intra-muscular cerebrolysin every three days.

1. Inhibition of apoptosis.

2. Improving synaptic plasticity and induction of neurogenesis.

3. Augmenting the proliferation, differentiation, and migration of adult subventricular zone neural progenitor stem cells, contributing to neurogenesis.

4. Induction of stem-cell proliferation in the brain.

This study suggested that intramuscular cerebrolysin is a promising agent for a new effective treatment of Charcot Marie tooth disease.

The author would like to express his gratitude for the parents of the patients for accepting publishing the photos of their child.