Elena Gallardo1, María J Sedano2, Pedro Orizaola3, Pascual Sánchez-Juan2, Andrea González-Suárez2, Antonio García3, Nuria Terán-Villagrá4, María Ruiz-Soto5, Rosa Landeras Álvaro1, María T Berciano5, Miguel Lafarga5, José Berciano6. 1. Service of Radiology, University Hospital "Marqués de Valdecilla", "Instituto de Investigación Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC) and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain. 2. Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain. 3. Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain. 4. Service of Pathology, University Hospital "Marqués de Valdecilla", Santander, Spain. 5. Department of Anatomy and Cell Biology, UC, IDIVAL and CIBERNED, Santander, Spain. 6. Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain. Electronic address: jaberciano@humv.es.
Abstract
OBJECTIVE: Although prevailing spinal nerve involvement has been recognized in a few detailed Guillain-Barré syndrome (GBS) autopsy reports, imaging studies addressing this question in cervical nerves are lacking. METHODS: We describe clinical, electrophysiological, ultrasonographic (US) and pathological findings in six consecutive early GBS patients, evaluated within 10 days of onset. RESULTS:Patients' ages ranged from 37 to 80 years. Five patients required mechanical ventilation, two of them having died 9 and 28 days after onset. Upper- and lower-limb nerve US showed abnormal findings in just 8.8% of scanned peripheral nerves. In comparison with 46 aged-matched control subjects, US of the fifth to seventh cervical nerves showed changes in four cases, which consisted of significant nerve enlargement, blurred boundaries of the corresponding ventral rami, or both. Autopsy study in one case demonstrated that pathology, consisting of demyelination and endoneurial inflammatory oedema, mainly involved cervical and lumbar nerves. CONCLUSIONS: In early GBS inflammatory oedema of spinal nerves is a pathogenically relevant feature to understanding the mechanism of ascending paralysis, particularly when conventional electrophysiological studies are normal or not diagnostic. SIGNIFICANCE: Findings advocate the use of cervical nerve US in early GBS.
RCT Entities:
OBJECTIVE: Although prevailing spinal nerve involvement has been recognized in a few detailed Guillain-Barré syndrome (GBS) autopsy reports, imaging studies addressing this question in cervical nerves are lacking. METHODS: We describe clinical, electrophysiological, ultrasonographic (US) and pathological findings in six consecutive early GBSpatients, evaluated within 10 days of onset. RESULTS:Patients' ages ranged from 37 to 80 years. Five patients required mechanical ventilation, two of them having died 9 and 28 days after onset. Upper- and lower-limb nerve US showed abnormal findings in just 8.8% of scanned peripheral nerves. In comparison with 46 aged-matched control subjects, US of the fifth to seventh cervical nerves showed changes in four cases, which consisted of significant nerve enlargement, blurred boundaries of the corresponding ventral rami, or both. Autopsy study in one case demonstrated that pathology, consisting of demyelination and endoneurial inflammatory oedema, mainly involved cervical and lumbar nerves. CONCLUSIONS: In early GBSinflammatory oedema of spinal nerves is a pathogenically relevant feature to understanding the mechanism of ascending paralysis, particularly when conventional electrophysiological studies are normal or not diagnostic. SIGNIFICANCE: Findings advocate the use of cervical nerve US in early GBS.
Authors: José Berciano; María J Sedano; Ana L Pelayo-Negro; Antonio García; Pedro Orizaola; Elena Gallardo; Miguel Lafarga; María T Berciano; Bart C Jacobs Journal: J Neurol Date: 2016-06-17 Impact factor: 4.849
Authors: Sonja E Leonhard; Melissa R Mandarakas; Francisco A A Gondim; Kathleen Bateman; Maria L B Ferreira; David R Cornblath; Pieter A van Doorn; Mario E Dourado; Richard A C Hughes; Badrul Islam; Susumu Kusunoki; Carlos A Pardo; Ricardo Reisin; James J Sejvar; Nortina Shahrizaila; Cristiane Soares; Thirugnanam Umapathi; Yuzhong Wang; Eppie M Yiu; Hugh J Willison; Bart C Jacobs Journal: Nat Rev Neurol Date: 2019-09-20 Impact factor: 42.937