Muscle MRI in severe Guillain–Barré syndrome with motor nerve inexcitability

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• 作者：María J. Sedano (1)
  Ana Canga (2)
  Carmen de Pablos (3)
  José M. Polo (1)
  José Berciano (1)
  
• 关键词：Acute inflammatory demyelinating polyneuropathy ; Acute motor axonal and motor ; sensory axonal neuropathy ; Axonal degeneration ; Demyelination ; Guillain–Barré syndrome ; Magnetic resonance imaging ; Muscle denervation ; Nerve conduction ; Nerve inexcitability
• 刊名：Journal of Neurology
• 出版年：2013
• 出版时间：June 2013
• 年：2013
• 卷：260
• 期：6
• 页码：1624-1630
• 全文大小：381KB
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• 作者单位：María J. Sedano (1)
  Ana Canga (2)
  Carmen de Pablos (3)
  José M. Polo (1)
  José Berciano (1)
  
  1. Service of Neurology, University Hospital “Marqués de Valdecilla (IFIMAV)- University of Cantabria and “Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)- Santander, Spain
  2. Service of Radiology, University Hospital “Marqués de Valdecilla (IFIMAV)- University of Cantabria, Santander, Spain
  3. Service of Clinical Neurophysiology, University Hospital “Marqués de Valdecilla (IFIMAV)- Santander, Spain
  
• ISSN：1432-1459

文摘

We report on the clinical, electrophysiological, and lower-limb musculature MRI findings in a severe demyelinating Guillain–Barré syndrome (GBS) patient with follow-up over 6?months. After 3?weeks of tetraplegia and mechanical ventilation, there was progressive improvement until almost complete recovery. On day 4 after onset, electrophysiological study revealed absent F waves and widespread conduction block. On four further electrophysiological studies on days 12, 19, 45, and 150, there was marked and reversible slow down of motor conduction velocities in upper-limb nerves, and persistent inexcitability of lower-limb nerves. Mild signs of active denervation were recorded in calf and foot muscles as of day 45. On day 39, MRI T2-weighted fat-suppressed images showed patchy hypersignal of variable intensity involving pelvic, thigh, and calf muscles, which disappeared in a second imaging study on day 190; in this study T1-weighted images did not disclose muscle fatty atrophy. We conclude that in severe demyelinating GBS prolonged motor nerve inexcitability should not necessarily be taken as a predictor of poor prognosis, and that MRI is useful in assessing the topography and evolution of muscle denervation.