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Guillian Barre Syndrome

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This was a child who had an antecedent viral infection

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and presented with lower extremity weakness and saddle

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anesthesia, effectively a cauda equina syndrome.

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The imaging of the brain was normal.

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The imaging on the non contrast scans,

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which I'll show eventually was, also normal.

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And then we got to the post gadolinium-enhanced scan.

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So on this child,

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we look at the contrast enhanced images of the cervical

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and upper thoracic region, and this is...

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I would pass this.

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This is basically normal vascularity that you see on the

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surface of the spinal cord and no enhancement

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in the spinal cord. However,

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when we get to the thoracolumbar junction,

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all of a sudden, we start seeing this enhancement on the

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surface of the conus medullaris extending

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into the cauda equina nerve roots.

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So what I'm looking at is the bright signal intensity

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enhancement on the surface of the spinal cord.

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So this is outside the spinal cord, therefore,

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intradural extramedullary.

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And then we have the cauda equina nerve roots,

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which are clumped together and are

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showing prominent enhancement.

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If we look at the axial scans through the cauda equina

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nerve roots, we see them all diffusely enhancing.

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Now, one point to be made is that the nerve roots

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do not appear to be enlarged.

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So remember

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in the past, we've seen cases of neurofibromatosis,

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in which we saw schwannomas and neurofibromas of the

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nerve roots, and that assumed an enlarged

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nerve root appearance.

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Here, in this patient who has Guillain-Barre syndrome,

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the nerve roots are not enlarged,

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but they are diffusely enhancing.

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And just to make sure that we're all agreed,

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here is the post gadolinium enhanced scan through the

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brain showing no enhancement or abnormality. On the

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spinal evaluation on T2-weighted scans,

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you're seeing flow artifacts of prominent CSF flow,

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but no abnormalities in the spinal cord, and nothing that

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can be really determined on the cauda equina nerve root

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evaluation on T2 weighted imaging.

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So this is almost a purely post gadolinium diagnosis

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that is made. In this case Guillain-Barre syndrome.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Spine

Neuroradiology

Musculoskeletal (MSK)

MRI

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