Abstract
Guillain-Barré syndrome (GBS) is defined as an acute inflammatory demyelinating polyradiculoneuropathy (AIDP) of the peripheral nervous system. Reports on central nervous system involvement in patients with GBS are rare and the histopathological analysis was usually restricted to conventional staining techniques. We were able to investigate four cases with GBS at autopsy in respect to the inflammatory infiltrates and histopathological changes in the spinal cord by immunohistochemistry using a panel of antibodies recognizing lymphocytes and different macrophage-activation antigens. There were increased inflammatory cell infiltrates comprising lymphocytes and macrophages in the spinal cord of two cases. In one of these two cases, GBS predominantly affecting the motor system similar to acute motor axonal neuropathy (AMAN) developed following hepatitis B vaccination; in the second one, GBS developed rapidly 4 days after onset of intravenous purified GM1-ganglioside application affecting the motor as well as the sensory system, resembling acute motor sensory axonal neuropathy (AMSAN). Impairment of the spinal anterior horn cells with their axons was suggested to be responsible for prolonged motor symptoms and the predominantly axonal type of neuropathy at least as a late-stage feature in these two cases with fatal outcome. Insignificant cellular infiltrates in the spinal cord were noted in the other two GBS cases. Focal cellular infiltration of spinal nerve roots and meninges was similar in all cases.
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References
Alter M (1990) The epidemiology of Guillain-Barré syndrome. Ann Neurol 27 Suppl:S7–S12
Anon (1991) Komplikationen mit Todesfolge nach Rinderhirngangliosid GMS (SYGEN). Arznei-Telegramm i:8
Asbury AK, Arnason BG, Adams RD (1969) The inflammatory lesion in idiopathic polyneuritis. Its role in pathogenesis. Medicine (Baltimore) 48:173–215
Berlit P (1989) Cronassial. Tägl Praxis 30:358–360
Brück W, Porada P, Poser S, Rieckmann P, Hanefeld F, Kretzschmar HA, Lassmann H (1995) Monocyte/macrophage differentiation in early multiple sclerosis lesions. Ann Neurol 38:788–796
De la Monte SM, Ropper AH, Dickersin GR, Harris NL, Ferry JA, Richardson EP Jr (1986) Relapsing central and peripheral demyelinating diseases. Unusual pathologic features. Arch Neurol 43:626–629
Dehaene I, Martin JJ, Geens K, Cras P (1986) Guillain-Barré syndrome with ophthalmoplegia: clinicopathologic study of the central and peripheral nervous systems, including the oculomotor nerves. Neurology 36:851–854
Dowling PC, Cook SD (1981) Role of infection in Guillain-Barré syndrome: laboratory confirmation of herpesviruses in 41 cases. Ann Neurol 9:44–55
Feasby TE (1994) Axonal Guillain-Barré syndrome. Muscle Nerve 17:678–679
Feasby TE, Gilbert JJ, Brown WF, Bolton CF, Hahn AF, Koopman WF, and Zochodne DW (1986) An acute axonal form of Guillain-Barré polyneuropathy. Brain 109:1115–1126
Feasby TE, Hahn AF, Brown WF, Bolton CF, Gilbert JJ, Koopman WJ (1993) Severe axonal degeneration in acute Guillain-Barré syndrome: evidence of two different mechanisms? J Neurol Sci 116:185–192
Griffin JW, Li CY, Ho TW, Xue P, Macko C, Gao CY, Yang C, Tian M, Mishu B, Cornblath DR (1995) Guillain-Barré syndrome in northern China. The spectrum of neuropathological changes in clinically defined cases. Brain 118:577–595
Grotto I, Mandel Y, Ephros M, Ashkenazi I, Shemer J (1998) Major adverse reactions to yeast-derived hepatitis B vaccines—a review. Vaccine 16:329–334
Hartung HP, Pollard JD, Harvey GK, Toyka KV (1995) Immunopathogenesis and treatment of the Guillain-Barré syndrome—Part II. Muscle Nerve 18:154–164
Haymaker W, Kernohan JW (1949) The Landry-Guillain-Barré syndrome: a clinicopathologic report of fifty fatal cases and a critique of the literature. Medicine (Baltimore) 28:59–141
Hemachudha T, Griffin DE, Chen WW, Johnson RT (1988) Immunologic studies of rabies vaccination-induced Guillain-Barré syndrome. Neurology 38:375–378
Honavar M, Tharakan JK, Hughes RA, Leibowitz S, Winer JB (1991) A clinicopathological study of the Guillain-Barré syndrome. Nine cases and literature review. Brain 114:1245–1269
Hughes RAC (1990) Guillain-Barré syndrome. Springer, London Berlin Heidelberg
Illa I, Ortiz N, Gallard E, Juarez C, Grau JM, Dalakas MC (1995) Acute axonal Guillain-Barré syndrome with IgG antibodies against motor axons following parenteral gangliosides. Ann Neurol 38:218–224
Kaldor J, Speed BR (1984) Guillain-Barré syndrome and Campylobacter jejuni: a serological study. Br Med J (Clin Res Ed) 288:1867–1870
Kiefer R, Kieseier BC, Brück W, Hartung HP, Toyka KV (1998) Macrophage differentiation antigens in acute and chronic autoimmune polyneuropathies. Brain 121:469–479
Klemola E, Weckman N, Haltia K, Kaariainen L (1967) The Guillain-Barré syndrome associated with acquired cytomegalovirus infection. Acta Med Scand 181:603–607
Kuwabara S, Ogawara K, Sung JY, Mori M, Kanai K, Hattori T, Yuki N, Lin CS, Burke D, Bostock H (2002) Differences in membrane properties of axonal and demyelinating Guillain-Barré syndromes. Ann Neurol 52:180–187
Landi G, D'Alessandro R, Dossi BC, Ricci S, Simone IL, Ciccone A (1993) Guillain-Barré syndrome after exogenous gangliosides in Italy. BMJ 307:1463–1464
Latov N, Wokke JHJ, Kelly JJ Jr (1998) Immunological and infectious diseases of the peripheral nerves. University Press, Cambridge, p 435
Maier H, Schmidbauer M, Pfausler B, Schmutzhard E, Budka H (1997) Central nervous system pathology in patients with the Guillain-Barré syndrome. Brain 120:451–464
Mäurer M, Toyka KV, Gold R (2002) Immune mechanisms in acquired demyelinating neuropathies: lessons from animal models. Neuromuscul Disord 12:405–414
McKhann GM, Cornblath DR, Griffin JW, et al (1993) Acute motor axonal neuropathy: a frequent cause of acute flaccid paralysis in China. Ann Neurol 33:333–342
Moran AP, Prendergast MM, Hogan EL (2002) Sialosyl-galactose: a common denominator of Guillain-Barré and related disorders? J Neurol Sci 196:1–7
Nachamkin I (2002) Rabbit model of Guillain-Barré syndrome. Ann Neurol 52:127–128; author reply 128–129
Oomes PG, Jacobs BC, Hazenberg MP, Banffer JR, Meché FG van der (1995) Anti-GM1 IgG antibodies and Campylobacter bacteria in Guillain-Barré syndrome: evidence of molecular mimicry. Ann Neurol 38:170–175
Pilartz M, Jess T, Indefrei D, Schröder JM (2002) Adoptive transfer-experimental allergic neuritis in newborn Lewis rats results in inflammatory infiltrates, mast cell activation, and increased Ia expression with only minor nerve fiber degeneration. Acta Neuropathol 104:513–524
Rosenblum WI, Budzilovich G, Feigin I (1966) Lesions of the spinal cord in polyradiculoneuropathy of unknown aetiology and a possible relationship with the Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 29:69–76
Schonberger LB, Hurwitz ES, Katona P, Holman RC, Bregman DJ (1981) Guillain-Barré syndrome: its epidemiology and associations with influenza vaccination. Ann Neurol 9:31–38
Schönhöfer PS (1991) Letter to the editor. Lancet 338:757
Sindern E, Schröder JM, Krismann M, Malin JP (2001) Inflammatory polyradiculoneuropathy with spinal cord involvement and letal outcome after hepatitis B vaccination. J Neurol Sci 186:81–85
Willison HJ, Yuki N (2002) Peripheral neuropathies and anti-glycolipid antibodies. Brain 125:2591–2625
Yuki N, Yoshino H, Sato S, Miyatake T (1990) Acute axonal polyneuropathy associated with anti-GM1 antibodies following Campylobacter enteritis. Neurology 40:1900–1902
Yuki N, Sato S, Itoh T, Miyatake T (1991) HLA-B35 and acute axonal polyneuropathy following Campylobacter infection. Neurology 41:1561–1563
Yuki N, Kuwabara S, Koga M, Hirata K (1999) Acute motor axonal neuropathy and acute motor-sensory axonal neuropathy share a common immunological profile. J Neurol Sci 168:121–126
Yuki N, Yamada M, Koga M, Odaka M, Susuki K, Tagawa Y, Ueda S, Kasama T, Ohnishi A, Hayashi S, Takahashi H, Kamijo M, Hirata K (2001) Animal model of axonal Guillain-Barré syndrome induced by sensitization with GM1 ganglioside. Ann Neurol 49:712–720
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The technical assistance of Hannelore Wiederholt and Astrid Knischewski, and the secretarial help of Ingrid Schmitt are gratefully acknowledged.
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Müller, H.D., Beckmann, A. & Schröder, J.M. Inflammatory infiltrates in the spinal cord of patients with Guillain-Barré syndrome. Acta Neuropathol 106, 509–517 (2003). https://doi.org/10.1007/s00401-003-0768-0
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DOI: https://doi.org/10.1007/s00401-003-0768-0