Prospective evaluation of MRI lumbosacral nerve root enhancement in acute Guillain-Barre syndrome

Abstract

Nerve root enhancement of the cauda equina occurs in Guillain-Barré syndrome (GBS), but the frequency, diagnostic value, and meaning of this finding is unknown. We prospectively obtained gadolinium-enhanced lumbosacral spine MRIs in 24 consecutive patients with acute GBS and blindly rated nerve root enhancement as absent, mild, or prominent. The MRIs were obtained 13 days, mean, after onset of symptoms (range 2 to 42 days). Twenty of 24 patients had cauda equina nerve root enhancement, which was mild in 6 and prominent in 14. Eighteen of 19 with "typical" GBS had enhancement, compared with 2 of 5 with a variant presentation. Sixty percent of patients with prominent enhancement had severe back or leg pain in contrast to 10% of patients with mild or no enhancement. The GBS disability grade (0 to 5 scale) was higher in patients with prominent enhancement, and significantly fewer patients with prominent nerve root enhancement could walk independently by 2 months. There was no relationship between nerve root enhancement and the timing of the MRI, CSF protein, any of several EMG abnormalities, duration of hospitalization, mean disability grade at 2 months, or the time required for patients to improve to grade 2. In two patients, the EMGs at 11 and 20 days, respectively, were normal except for slightly prolonged F-responses and neurogenic recruitment, but there were prominent nerve root enhancement and an elevated CSF protein. Enhancement of the cauda equina nerve roots with gadolinium on lumbosacral MRI is 83% sensitive of acute GBS and was present in 95% of typical cases. This finding may be useful when electrophysiologic abnormalities are equivocal. In addition, conspicuous nerve root enhancement correlates with pain, GBS disability grade, and duration of recovery.

Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis

“…Neurosarcoidosis, chronic meningitis, Guillain-Barre syndrome, and many infectious cases of meningitides can cause the linear leptomeningeal enhancement seen on MRI. 49 Bacterial and viral meningeal inflammation tends to appear as linear enhancement, whereas fungal inflammation is generally nodular. 50 Primary nerve sheath tumors in the subarachnoid space may also appear as areas of nodular enhancement.…”

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

“…[12][13][14][15][16] Although prominent nerve root enhancement has been observed along with an increased severity of leg weakness, 14 the correlation between intracranial findings and clinical outcomes is poorly established. 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.…”

Perspectives in Diagnosis and Treatment of Rabies Viral Encephalitis: Insights from Pathogenesis

“…In fact, one of the initial historical cases of the acute motor sensory variant of GBS was found, on review, to be a case of paralytic rabies [87]. Participation of autoantibodies against peripheral nerve antigens in the evolution of paralysis is also suggested by vivid enhancement of ventral and dorsal nerve roots on magnetic resonance imaging, similar to GBS [77,88]. However, neither neutralizing antibodies nor antiganglioside nor myelin basic protein antibodies have been consistently demonstrated in CSF in paralytic rabies [78,81,89].…”