Nerve Root Enhancement on Spinal MRI in Pediatric Guillain-Barré Syndrome

Mulkey, Sarah B.; Glasier, Charles M.; El-Nabbout, Bassem; Walters, William D.; Ionita, Cristian; McCarthy, Michael H.; Sharp, Gregory B.; Shbarou, Rolla

doi:10.1016/j.pediatrneurol.2010.05.011

Cited by 62 publications

(47 citation statements)

References 15 publications

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“…Cerebrospinal fluid (CSF) may show increased protein with a normal white cell count (albumin-cytologic dissociation). 3,5,7,11 Magnetic resonance imaging may show nerve root enhancement with administration of gadolinium. 3,7,11 Although most patients have this finding on initial scan, it may not be seen until up to a week after symptom onset.…”

Section: Diagnosismentioning

confidence: 99%

“…3,5,7,11 Magnetic resonance imaging may show nerve root enhancement with administration of gadolinium. 3,7,11 Although most patients have this finding on initial scan, it may not be seen until up to a week after symptom onset. 11 The presence of nerve root enhancement, as opposed to enhancement within spinal cord, helps differentiate GBS from TM.…”

Section: Diagnosismentioning

confidence: 99%

“…3,7,11 Although most patients have this finding on initial scan, it may not be seen until up to a week after symptom onset. 11 The presence of nerve root enhancement, as opposed to enhancement within spinal cord, helps differentiate GBS from TM. 11 Brain MRI may show cranial nerve involvement in patients with cranial neuropathy with cranial nerves 3 and 6 most commonly affected.…”

Section: Diagnosismentioning

confidence: 99%

“…7,8,10 There is male predominance in GBS, and the mean age is 4.9 (range, 5-7.5 years). [4][5][6][7]10,11 Presenting signs include weakness and areflexia or hyporeflexia in nearly all patients as well as neuropathy, with myalgias or leg pain and paraesthesias. 3,4,[6][7][8]10 Children experience pain to a much higher extent than adults.…”

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The Child With Acute Weakness

Morgan

2015

Clinical Pediatric Emergency Medicine

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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The Child With Acute Weakness

Morgan

2015

Clinical Pediatric Emergency Medicine

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“…This occurs in up to 80-90 % of patients particularly in children and in patients with severe weakness and severe leg and back pain (Fig. 28.3 ) [ 124,125 ] . Occasionally, the facial nerves may also enhance with gadolinium in GBS patients with facial palsies [ 126 ] .…”

Section: Imaging Studiesmentioning

confidence: 99%

Guillain-Barré Syndrome and Related Disorders

Piccione

Salame

Katirji

2013

Neuromuscular Disorders in Clinical Practice

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Neurologic Complications Associated With the Zika Virus in Brazilian Adults

et al. 2017

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There are no prospective cohort studies assessing the incidence and spectrum of neurologic manifestations secondary to Zika virus (ZIKV) infection in adults.OBJECTIVE To evaluate the rates of acute ZIKV infection among patients hospitalized with Guillain-Barré syndrome (GBS), meningoencephalitis, or transverse myelitis. DESIGN, SETTING, AND PARTICIPANTSA prospective, observational cohort study was conducted at a tertiary referral center for neurological diseases in Rio de Janeiro, Brazil, between December 5, 2015, and May 10, 2016, among consecutive hospitalized adults (>18 years of age) with new-onset acute parainfectious or neuroinflammatory disease. All participants were tested for a series of arbovirosis. Three-month functional outcome was assessed.INTERVENTIONS Samples of serum and cerebrospinal fluid were tested for ZIKV using real-time reverse-transcriptase-polymerase chain reaction and an IgM antibody-capture enzyme-linked immunosorbent assay. Clinical, radiographic (magnetic resonance imaging), electrophysiological, and 3-month functional outcome data were collected. MAIN OUTCOMES AND MEASURESThe detection of neurologic complications secondary to ZIKV infection.RESULTS Forty patients (15 women and 25 men; median age, 44 years [range, 22-72 years]) were enrolled, including 29 patients (73%) with GBS (90% Brighton level 1 certainty), 7 (18%) with encephalitis, 3 (8%) with transverse myelitis, and 1 (3%) with newly diagnosed chronic inflammatory demyelinating polyneuropathy. Of these, 35 patients (88%) had molecular and/or serologic evidence of recent ZIKV infection in the serum and/or cerebrospinal fluid. Of the patients positive for ZIKV infection, 27 had GBS (18 demyelinating, 8 axonal, and 1 Miller Fisher syndrome), 5 had encephalitis (3 with concomitant acute neuromuscular disease), 2 had transverse myelitis, and 1 had chronic inflammatory demyelinating polyneuropathy. Admission to the intensive care unit was required for 9 patients positive for ZIKV infection (26%), and 5 (14%) required mechanical ventilation. Compared with admission during the period from December 5, 2013, to May 10, 2014 (before the Brazilian outbreak of ZIKV), admissions for GBS increased from a mean of 1.0 per month to 5.6 per month, admissions for encephalitis increased from 0.4 per month to 1.4 per month, and admissions for transverse myelitis remained constant at 0.6 per month. At 3 months, 2 patients positive for ZIKV infection (6%) died (1 with GBS and 1 with encephalitis), 18 (51%) had chronic pain, and the median modified Rankin score among survivors was 2 (range, 0-5). CONCLUSIONS AND RELEVANCEIn this single-center Brazilian cohort, ZIKV infection was associated with an increase in the incidence of a diverse spectrum of serious neurologic syndromes. The data also suggest that serologic and molecular testing using blood and cerebrospinal fluid samples can serve as a less expensive, alternative diagnostic strategy in developing countries, where plaque reduction neutralization testing is impractical.

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Nerve Root Enhancement on Spinal MRI in Pediatric Guillain-Barré Syndrome

Cited by 62 publications

References 15 publications

The Child With Acute Weakness

The Child With Acute Weakness

Guillain-Barré Syndrome and Related Disorders

Neurologic Complications Associated With the Zika Virus in Brazilian Adults

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