CASE 1504 Published on 01.07.2002

Guillain-Barré syndrome

Section

Neuroradiology

Case Type

Clinical Cases

Authors

F. Tercan, T. Yýlmaz, H. Altay, S. Bayraktaroglu, R. N. Sener

Patient

6 years, male

Categories

No Area of Interest ; Imaging Technique MR

No Procedure ; No Special Focus ;

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Clinical History

Acute lower extremity weakness and urination difficulty.

Imaging Findings

The patient presented with lower extremity weakness of 7 days' duration and urination difficulty for one day. Electrodiagnostic studies revealed prolonged distal latencies and slowed motor conduction velocities, confirming an acute demyelinating polyradiculoneuropathy. An MRI examination was performed including T1-weighted images obtained after intravenous administration of paramagnetic contrast medium.

Discussion

Guillain-Barré syndrome (GBS) is an acute demyelinating neuropathy characterised by sudden, symmetric progressive weakness, hyporeflexia or areflexia, and little or no sensory changes. Although the precise cause of GBS is unclear, most evidence points to an immune-mediated phenomenon. The diagnosis of GBS mainly depends on the typical clinical picture combined with supportive laboratory data and electrophysiological criteria.

On MRI examination with T1-weighted images with contrast medium it is known that intrathecal nerve roots normally do not enhance, because of the blood-nerve root barrier. As the nerve root travels peripherally, however, progressive loss of the blood-nerve root barrier occurs and by the level of the dorsal root ganglia, enhancement is a normal finding. Abnormal enhancement of the cauda equina has been reported in AIDS-related polyradiculopathy, sarcoidosis, lymphoma, metastatic conditions, and GBS. The abnormal enhancement and thickening of intrathecal nerve roots in GBS is suggestive of the breakdown of the blood-nerve barrier and is correlated with perivascular disease as there is lymphocytic and macrophagic infiltration around endoneural vessels that is associated with demyelination of the affected nerves. The thickness and the degree of enhancement tends to get smaller with clinical resolution of the symptoms after immunoglobulin therapy. It should be noted that T1-weighted images without contrast medium, and T2-weighted images are usually negative in GBS.

Differential Diagnosis List

Guillain-Barré syndrome

Final Diagnosis

Guillain-Barré syndrome

References

[1] Wilmshurst JM, Thomas NH, Robinson RO, Bingham JB, Pohl KR. Lower limb and back pain in Guillain-Barre syndrome and associated contrast enhancement in MRI of the cauda equina.
Acta Paediatr. 2001 Jun;90(6):691-4. (PMID: 11440105)

[2] Matsuki M, Okada N, Matsuo M. Case report: MR findings of Guillain-Barre syndrome.
Radiat Med. 1998 Mar-Apr;16(2):133-5. (PMID: 9650902)

[3] Fuchigami T, Iwata F, Noguchi Y, Kohira R, Yamazaki H, Okubo O, Utsumi Y, Harada K. Magnetic resonance imaging of the cauda equina in two patients with Guillain-Barre syndrome.
Acta Paediatr Jpn. 1997 Oct;39(5):607-10. (PMID: 9363661)

[4] Perry JR, Fung A, Poon P, Bayer N. Magnetic resonance imaging of nerve root inflammation in the Guillain-Barre syndrome.
Neuroradiology. 1994;36(2):139-40. (PMID: 8183455)

[5] Baran GA, Sowell MK, Sharp GB, Glasier CM. MR findings in a child with Guillain-Barre syndrome.
AJR Am J Roentgenol. 1993 Jul;161(1):161-3. (PMID: 8517296)

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