Case 39 - Guillain-Barré Syndrome

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Examination: Brain MRI without and with contrast.

Total spine MRI without and with contrast.

Indication: Progressive lower extremity weakness over the course of 1 or 2 weeks and diminished/absent lower extremity reflexes. Recent history of outdoor camping.

Technique: Multiplanar MR imaging of the brain and total spine was performed without and with the intravenous administration of gadolinium contrast. Acquired sequences through the brain include sagittal T1, axial T2, T2 FLAIR, axial diffusion tensor imaging with corresponding calculated FA and ADC maps, post contrast axial T1. Acquired sequences through the spine included sagittal T1, T2, axial T2, post contrast sagittal and axial T1.

Comparison: No relevant prior imaging is available.

Findings:

Brain:

The postcontrast acquisition reveals symmetric enhancement of cranial nerves V, and differential enhancement of right cranial nerve III. There may be subtle leptomeningeal enhancement within the posterior fossa illustrated by linear enhancement along the fissures of the inferior cerebellum on the axial postcontrast acquisition.

There is no supratentorial mass effect or shift of midline structures.

There is no abnormal extra-axial fluid collection. Lateral and third ventricles are normal and proportionate to the subarachnoid spaces. There is no hydrocephalus. No evidence of acute territorial infarct. Major intracranial flow voids are preserved. There is no mastoid effusion.

Visualized paranasal sinuses are well aerated. The globes and orbits are symmetric.

Total spine:

There is diffuse pial enhancement involving the ventral and dorsal spinal nerve roots. No definite intramedullary cord signal abnormality or enhancement is present. The there is no restricted diffusion within the cord.

There is anatomic alignment and position of the vertebral bodies and posterior elements of the cervical, thoracic, and lumbosacral spine.

Vertebral body heights are preserved. Bone marrow signal is normal at all visualized levels. There is subtle loss of intervertebral disc height and signal at the level of C5-C6. Annular contours are normal. There is no canal stenosis nor cord compression. No neural foraminal narrowing within the cervical, thoracic, nor lumbosacral spine.

Limited visualization of the intrathoracic structures reveals an aberrant right subclavian artery. Limited visualization of the retroperitoneal structures reveals no abnormality.

IMPRESSION:

Extensive pial enhancement of the dorsal and ventral spinal nerve roots and a mild degree of symmetric leptomeningeal enhancement within the posterior fossa as well as enhancement of cranial nerves III and V suggests infectious polyneuropathy such as Neuroborelliosis particularly in the setting of recent outdoor camping. Other infectious or inflammatory polyneuropathies may have a similar presentation and should be considered within the differential diagnosis.