0:01

This was a patient who,

0:02

two weeks after a bout with gastroenteritis,

0:06

developed a flaccid paralysis of the lower extremities.

0:11

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

0:15

And Guillain-Barré most characteristically occurs after,

0:18

for example, a campylobacter or antivirus infection.

0:23

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

0:27

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

0:32

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

0:35

of the cauda equina extending to the conus medullaris.

0:39

On the post-gadolinium axial scan,

0:41

you see all these nerve roots in the thecal sac

0:44

showing avid contrast enhancement.

0:47

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

0:52

spinal cord at the conus medullaris.

0:56

Classically,

0:57

the patients with Guillain-Barré have involvement

1:00

of the motor nerves in the motor system,

1:03

which may be demonstrated by greater enhancement of the

1:07

anterior nerve roots as opposed to the posterior nerve roots.

1:10

Frankly, in this case,

1:12

all the nerve roots are showing contrast enhancement.

1:14

Although the clinical history is great for Guillain-Barré,

1:17

this is a type of individual who will get lumbar

1:20

puncture and make sure that it's not

1:23

a bacterial meningitis that's causing enhancement

1:28

of the cauda equina nerve roots.

1:30

Tuberculosis is one of the causes of a meningitis of this

1:36

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

1:42

streptococcus, staphylococcus may lead to a meningitis that

1:47

can affect the cauda equina nerve roots.

Case 39 - Guillain-Barré Syndrome

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