Guillain Barre syndrome – Spinal MR findings

Abstract

A 10 yr old male child presented with history of acute onset rapidly progressive weakness of bilateral lower limbs. There was no history of associated fever or trauma. No bowel or bladder involvement was noted. On examination there was bilateral lower limb areflexia with little sensory involvement. The rest of the systemic examination was unremarkable. Cerebrospinal Fluid (CSF) examination revealed elevated protein level (800 mg/dl, normal range is 20–40 mg/dl) consistent with albumin cytological dissociation with nerve conduction study showing slow conduction consistent with demyelinating polyneuropathy. Based on clinical signs, symptoms and lab investigation diagnosis of Guillain Barre syndrome (GBS) was made and patient was put on intravenous immunoglobulin therapy. Before starting the treatment magnetic resonance imaging (MRI) spine was performed to rule out compressive myelopathy or myelitis. Pre contrast images were normal however post contrast images of spine revealed enhancement of cauda equina nerve roots and conus medullaris (Fig. 1) with preferential enhancement of ventral spinal nerve roots as compared to dorsal nerve roots (Fig. 2) GBS is an acute symmetrical inflammatory demyelinating polyneuropathy [1] that involves the peripheral nervous system. Patients generally present with acute