3 day history of leg weakness. Now acutely worse.
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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
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.
- Fokke C, Van den berg B, Drenthen J et-al. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain. 2014;137 (Pt): 33-43. doi:10.1093/brain/awt285 - Pubmed citation
- Hughes RA, Swan AV, Van doorn PA. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2010;(6): CD002063. doi:10.1002/14651858.CD002063.pub4 - Pubmed citation