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Case 39 - Guillain-Barré Syndrome

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This was a patient who,

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two weeks after a bout with gastroenteritis,

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developed a flaccid paralysis of the lower extremities.

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That's sort of a classic history for Guillain-Barré syndrome.

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And Guillain-Barré most characteristically occurs after,

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for example, a campylobacter or antivirus infection.

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What we see with Guillain-Barré syndrome is nothing in the

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spinal cord, but when we do post-gadolinium enhanced scans,

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you see that there's marked enhancement of the nerve roots

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of the cauda equina extending to the conus medullaris.

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On the post-gadolinium axial scan,

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you see all these nerve roots in the thecal sac

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showing avid contrast enhancement.

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And this can go all the way up to involve the lower

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spinal cord at the conus medullaris.

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Classically,

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the patients with Guillain-Barré have involvement

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of the motor nerves in the motor system,

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which may be demonstrated by greater enhancement of the

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anterior nerve roots as opposed to the posterior nerve roots.

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Frankly, in this case,

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all the nerve roots are showing contrast enhancement.

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Although the clinical history is great for Guillain-Barré,

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this is a type of individual who will get lumbar

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puncture and make sure that it's not

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a bacterial meningitis that's causing enhancement

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of the cauda equina nerve roots.

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Tuberculosis is one of the causes of a meningitis of this

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type, but any of the usual suspects, including neisseria,

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streptococcus, staphylococcus may lead to a meningitis that

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can affect the cauda equina nerve roots.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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