Guillain-Barré syndrome: MR imaging findings of the spine in eight patients.

Byun, Woo Mok; Park, Won Kyu; Park, Bok Hwan; Ahn, Sang Ho; Hwang, Mi Soo; Chang, Jay Chun

doi:10.1148/radiology.208.1.9646804

Cited by 118 publications

(72 citation statements)

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“…13,17,18 It was previously suggested that enhancement solely of the anterior CE roots was indicative of GBS, but it is now known that both the anterior and posterior roots may be simultaneously involved. 13,18,19 We found that the involvement of the anterior CE roots was more intense and frequent, thus confirming that though nonspecific, selective or relatively more intense enhancement of the anterior CE roots favors the diagnosis of GBS.…”

Section: Involvement Of the Ce Rootssupporting

confidence: 67%

Redefining the Guillain-Barré Spectrum in Children: Neuroimaging Findings of Cranial Nerve Involvement

Zuccoli¹,

Panigrahy²,

Bailey³

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY: GBS and its MFS variant are acute polyneuropathies that are considered to represent a continuum rather than distinct entities, due to the overlap in their clinical features. Enhancement of the CE roots represents the neuroradiologic hallmark of GBS, while findings of neuroimaging studies in MFS are usually unremarkable. Our purpose was to evaluate the MR imaging findings of polyneuropathy in 17 children affected by GBS and its MFS variant. Fourteen of our 17 patients demonstrated CE enhancement, with predominant involvement of the anterior roots. Of 6 patients who underwent MR imaging of the brain, 5 had cranial nerve involvement. In children affected by GBS-MFS, involvement of the CE roots may be considered part of a more extensive autoimmune neuropathy, as demonstrated by enhancement of cranial nerves. Brain MR imaging should be considered in the routine evaluation in pediatric patients with GBS-MFS for the evaluation of the cranial nerves.

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Section: Involvement Of the Ce Rootssupporting

confidence: 67%

Redefining the Guillain-Barré Spectrum in Children: Neuroimaging Findings of Cranial Nerve Involvement

Zuccoli¹,

Panigrahy²,

Bailey³

et al. 2011

AJNR Am J Neuroradiol

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“…The differential diagnosis of our patient's findings includes the pure motor and axonal variant of GuillainBarré syndrome (acute motor axonal neuropathy (AMAN)). Byun et al [9] reported MRI findings for the spine in eight patients with Guillain-Barré syndrome and concluded that enhancement of the anterior spinal nerve roots alone is strongly suggestive of AMAN. However, the absence of an antecedent event, the short duration of time between the onset of symptoms and CSEA, the concordance in distribution of neurological disturbances with the extent of local anaesthetic delivery, the sphincteric involvement, and the prolonged neurological impairment did not support a diagnosis of AMAN in the present case.…”

Section: Discussionmentioning

confidence: 99%

Gadolinium enhancement of cauda equina after combined spinal–epidural anaesthesia

Takasu

Okita²,

Araki³

et al. 2010

BJR

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ABSTRACT. The occurrence of neurological symptoms after spinal anaesthesia has been reported with several local anaesthetics including lidocaine, prilocaine, mepivacaine, tetracaine and bupivacaine. Although hyperbaric bupivacaine is known to induce neurological symptoms less frequently than lidocaine, a few cases of cauda equina syndrome (CES) following the intraspinal injection of bupivacaine have been reported in the English literature. We describe lumbar MRI findings for a 29-year-old woman presenting with CES after caesarean section. Cauda equina syndrome (CES), a rare complication of spinal or epidural anaesthesia, results from injury to sacral roots in the neural canal. Because the nerves in the cauda equina lack a protective sheath as they pass through the distal end of the dural sac, they are particularly prone to injury from high concentrations of local anaesthetics. Although laboratory findings have suggested that lidocaine, mepivacaine and ropivacaine may have greater potential for neurotoxicity than bupivacaine [1], several cases of CES have been reported in association with the intrathecal injection of bupivacaine [2]. To the best of our knowledge, no spinal MRI findings have been presented for nerve root injury caused by spinal anaesthesia. Case reportA 29-year-old multiparous woman was admitted to the hospital in the 38th week of pregnancy for her second caesarean delivery. Her past medical history was unremarkable. On the second day of hospitalization, she went to the operating room. Combined spinalepidural anaesthesia (CSEA) was performed in the left decubitus position with 2.2 ml 0.5% hyperbaric bupivacaine administered intrathecally at the L3-4 interspace, followed by placement of a multiorifice epidural catheter at the T8-9 interspace. An 18-gauge epidural catheter was positioned 5 cm into the epidural space oriented in the cephalad direction to optimise cephalic spread of the anaesthetic. Surgery was allowed to proceed after sensory block from T5 to S5 was achieved. A total dose of 5.1 ml of 0.2% ropivacaine was administered using a patient-controlled epidural analgesia device over 75 min. Oxygen 3 l min -1 was given through a face mask; 20 min elapsed between induction of anaesthesia and uterine incision. The surgical procedure was completed without incident and the estimated blood loss was 800 ml.The patient did not fully recover from the motor and sensory blockade induced by CSEA, and at about 48 h post-partum was unable to walk because of lower extremity weakness. Neurological assessment confirmed sensory deficit to pinprick and vibration in the T3 to L5 distribution bilaterally with preservation of position sense. On the following day, she still exhibited hypaesthesia bilaterally in the T6 to L2 distribution with lower extremity weakness, which had shown minor improvement. Results of lumbosacral MRI without contrast medium were within normal limits, ruling out the possibility of spinal epidural haematoma or spinal infarction. Because the levels of sensory and motor dysfunction were nea...

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“…The cauda equina enhances after gadolinium in patients with Guillain-Barré syndrome (GBS) [1] because of a breakdown of the blood-nerve barrier that should be present [4].…”

mentioning

confidence: 99%

“…Byun et al in a retrospective review of MRI findings in patients with GBS concluded that while enhancement of the intrathecal spinal nerve roots is not specific to GBS, enhancement of the anterior spinal nerve roots in isolation is highly suggestive of GBS [4].…”

mentioning

confidence: 99%

“…With respect to immunocompromised patients, in particular those with acquired immune deficiency syndrome (AIDS), non-specific enhancement of nerve roots is demonstrated in AIDS-related polyradiculopathy in association with metastatic disease, arachoiditis (which can occur after infection, surgery and subarachnoid haemorrhage) was previously common after contrast myelography, but has decreased in incidence since the introduction of non-ionic contrast media [6], sarcoidosis and CMV infections [4]. CMV causing AIDS-related polyradiculopathy causes diffuse enhancement of the cauda equina in a manner similar to that of GBS [4].…”

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confidence: 99%

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Weakness after foreign travel in a 40-year-old man

et al. 2010

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Guillain-Barré syndrome: MR imaging findings of the spine in eight patients.

Abstract: Although the enhancement of the intrathecal spinal nerve roots is not specific to Guillain-Barré syndrome and can be seen in neoplasia and other inflammatory processes, the enhancement of only the anterior spinal nerve roots is strongly suggestive of Guillain-Barré syndrome.

Cited by 118 publications

References 0 publications

Redefining the Guillain-Barré Spectrum in Children: Neuroimaging Findings of Cranial Nerve Involvement

Redefining the Guillain-Barré Spectrum in Children: Neuroimaging Findings of Cranial Nerve Involvement

Gadolinium enhancement of cauda equina after combined spinal–epidural anaesthesia

Weakness after foreign travel in a 40-year-old man

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