Ultrasound and electrophysiologic findings in patients with Guillain–Barré syndrome at disease onset and over a period of six months

Abstract

ObjectiveTo investigate cross-sectional areas (CSAs) of several peripheral nerves including the vagus nerve and the diameter of spinal nerves as measured by nerve ultrasound (NUS) and nerve conduction studies (NCS) in Guillain–Barré syndrome (GBS) patients over at least six months compared to healthy controls. MethodsNUS and/or NCS of several nerves, the vagus nerve, and the 5th/6th cervical spinal nerves were performed in patients with GBS at days 2–3 after symptom onset, at days 10–14 after immunoglobulin therapy and after six months compared to healthy controls. Results27 GBS-patients and 31 controls were included. Using NUS significant enlargement was found in all measured nerves (P<0.001), except the sural nerve (P=0.086) compared to the controls at onset. The vagus (median 3.0mm2 vs. 2.0mm2, P<0.0001) and the cervical spinal nerves were significantly enlarged (median 3.5/4.0mm vs. 2.6/3.2mm, p<0.0001), the vagus most obviously in patients with autonomic dysregulation (AD, 4.0mm2). Six months later, NCS showed persisting pathology in CMAP-amplitudes with amelioration of F-wave pathology. NUS showed restitution in the spinal nerves (median 2.6/3.2mm) and the vagus (median 2.0mm2) in all patients excluding the vagus in those with persistent AD (median 4.0mm2). The peripheral nerves did not change significantly (P>0.05). ConclusionUltrasonographic detection of cervical spinal nerve enlargement supports the diagnosis of GBS in the early phase. Its regression may be a good parameter for the clinical restitution over time. Vagus enlargement may be a risk marker for development of AD. SignificanceUltrasound is a reliable diagnostic follow-up tool in early GBS.