Teaching Neuro Images : Variant of Guillain-Barré syndrome with spinal cord involvement

Abstract

A 48-year-old man presented with ascending sensory deficits over 12 hours, followed by urinary retention. He had areflexia, mild lower extremity weakness, sensory ataxia, and a T2 sensory level. Smooth pursuit was impaired, but cranial nerves were otherwise normal. Diagnostic evaluation demonstrated CSF cytoalbuminologic dissociation and demyelinating polyneuropathy fulfilling the electrodiagnostic criteria for Guillain-Barré syndrome (GBS).1 Laboratory evaluation had normal results, including vitamin B12; anti–neuromyelitis optica, antineuronal, and ganglioside antibodies; and oligoclonal bands. Myelopathy was confirmed on MRI (figure). This case highlights that acquired acute demyelination may rarely affect the peripheral and CNS simultaneously (GBS–transverse myelitis overlap syndrome), likely related to common autoimmune-mediated pathomechanisms.2