Muscle MRI in severe Guillain–Barré syndrome with motor nerve inexcitability
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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.
KeywordsAcute 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
Conflicts of interest
The authors declare no competing interests.
This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
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