Guillain–Barré syndrome

Case contributed by Dr Yune Kwong

Presentation

3 day history of leg weakness. Now acutely worse.

Patient Data

Age: 4
Gender: Male
Modality: MRI

The roots of the cauda equina (both dorsal and ventral) are seen to be enhancing. Cranial imaging (not shown) was normal.

CSF MICROSCOPY & CULTURE

Chemistry: Protein: 0.2  g/L (0.1-0.3), Glucose: 3.3 mmol/L (2.5-5.0), Lactate: 1.1 mmol/L (0-3.0)

Cell Count: Polymorphs: 0 x 10^6/L, Lymphocytes: 0 x 10^6/L, Total WCC: 0 x 10^6/L, RBC: 0 x 10^6/L

Gram Stain: No organisms seen

Culture: No growth

Case Discussion

Guillain–Barré syndrome is an acute polyradiculoneuropathy with variable clinical presentation. A history of antecedent infection can be elicited in 24-38% of patients. On CSF analysis, the cell count is normal in 85% of patients, and high protein values are seen in 64%. On MRI, preferential enhancement of the ventral roots has been described, but both ventral and dorsal roots can enhance, as in this case.

The finding of cauda equina nerve root enhancement is by itself not specific as it can be seen in a range of conditions, for example

The diagnosis of Guillain–Barré syndrome is dependent on a combination of clinical features, CSF analysis, nerve conduction studies, and the absence of an alternative diagnosis for weakness.

In this case, the patient made a remarkable recovery following intravenous immunoglobulin therapy.

PlayAdd to Share

Case Information

rID: 29893
Case created: 30th Jun 2014
Last edited: 28th Apr 2017
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.