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Erschienen in: Journal of Neurology 2/2017

17.06.2016 | Review

Proximal nerve lesions in early Guillain–Barré syndrome: implications for pathogenesis and disease classification

verfasst von: José Berciano, María J. Sedano, Ana L. Pelayo-Negro, Antonio García, Pedro Orizaola, Elena Gallardo, Miguel Lafarga, María T. Berciano, Bart C. Jacobs

Erschienen in: Journal of Neurology | Ausgabe 2/2017

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Abstract

Guillain–Barré syndrome (GBS) is an acute-onset, immune-mediated disorder of the peripheral nervous system. In early GBS, arbitrarily established up to 10 days of disease onset, patients could exhibit selective manifestations due to involvement of the proximal nerves, including nerve roots, spinal nerves and plexuses. Such manifestations are proximal weakness, inaugural nerve trunk pain, and atypical electrophysiological patterns, which may lead to delayed diagnosis. The aim of this paper was to analyze the nosology of early GBS reviewing electrophysiological, autopsy and imaging studies, both in acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor/motor-sensory axonal neuropathy (AMAN/AMSAN). Early electrophysiology showed either well-defined demyelinating or axonal patterns, or a non-diagnostic pattern with abnormal late responses; there may be attenuated M responses upon lumbar root stimulation as the only finding. Pathological changes predominated in proximal nerves, in some studies, most prominent at the sides where the spinal roots unite to form the spinal nerves; on very early GBS endoneurial inflammatory edema was the outstanding feature. In the far majority of cases, spinal magnetic resonance imaging showed contrast enhancement of cauda equina, selectively involving anterior roots in AMAN. Both in AIDP and AMAN/AMSAN, ultrasonography has demonstrated frequent enlargement of ventral rami of C5–C7 nerves with blurred boundaries, whereas sonograms of upper and lower extremity peripheral nerves exhibited variable and less frequent abnormalities. We provide new insights into the pathogenesis and classification of early GBS.
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Metadaten
Titel
Proximal nerve lesions in early Guillain–Barré syndrome: implications for pathogenesis and disease classification
verfasst von
José Berciano
María J. Sedano
Ana L. Pelayo-Negro
Antonio García
Pedro Orizaola
Elena Gallardo
Miguel Lafarga
María T. Berciano
Bart C. Jacobs
Publikationsdatum
17.06.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Neurology / Ausgabe 2/2017
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-016-8204-2

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