Tamiladu & Pondicherry Chapter of Indian Radiological and Imaging Association
Promoting the study and practice of Diagnostic Radiological Imaging Modalities in the states of Tamilnadu and Pondicherry
Answer to Quiz No. 12/2015 dated 17 May 2015
Gullian Barre syndrome
Acceptable differential diagnosis: Tuberculosis, Arachnoiditis, Lymphoma, Metastases
Findings
13 year old female patient presented to casualty with progressive bilateral lower limb weakness and referred for plain MRI whole spine. Plain study revealed no significant abnormality Further proceeded with contrast which showed smooth enhancement of the cauda equina nerve roots. Take Home: 1. Always do contrast on young patient with atypical clincal history. 2. Normally spinal nerve roots do not enhance following contrast administration.
Discussion
Gullian Barre Syndrome; An Acute Inflammatory Demyelinating Polyneuropathy (AIDP). Has autoimmune background, predominantly affecting peripheral nervous system usually preceded by an antecedent bacterial or viral infection. Presents as an ascending paralysis, weakness in lower limbs to begin with followed by involvement of upper limbs and the face. Role of MRI is to exclude other causes. On MRI findings usually include thickening and enhancement of the nerve roots of the cauda equina. The lymphocytic and macrophagic infiltration around endoneural vessels with associated demyelination of the affected nerves is suggested mechanism behind this abnormal enhancement. Treatment options include supportive, immunoglobulin and plasmapharesis. Differential diagnosis: Normally nerve roots of cauda equina don’t enhance. Any enhancement considered as abnormal. Enhancement of cauda equina nerve roots is a nonspecific finding, suggests breakdown of the blood-nerve barrier due to any reason. DDs include: Acute inflammatory polyneuropathy. Chronic inflammatory demyelinating polyneuropathy. AIDS-related cytomegalovirus polyradiculopathy. Arachnoiditis. Granulomatous - Tuberculosis , Sarcoidosis. Infiltrating neoplastic disorders like lymphoma, metastasis. Transverse myelitis. Nerve root compression by herniated disc. Idiopathic - GBS.
Contributed By:
Dr Subramanian Ilanchezhian, Senior Resident, Sri Ramachandra Medical College, Chennai.
Acceptable differential diagnosis: Tuberculosis, Arachnoiditis, Lymphoma, Metastases
Findings
13 year old female patient presented to casualty with progressive bilateral lower limb weakness and referred for plain MRI whole spine. Plain study revealed no significant abnormality Further proceeded with contrast which showed smooth enhancement of the cauda equina nerve roots. Take Home: 1. Always do contrast on young patient with atypical clincal history. 2. Normally spinal nerve roots do not enhance following contrast administration.
Discussion
Gullian Barre Syndrome; An Acute Inflammatory Demyelinating Polyneuropathy (AIDP). Has autoimmune background, predominantly affecting peripheral nervous system usually preceded by an antecedent bacterial or viral infection. Presents as an ascending paralysis, weakness in lower limbs to begin with followed by involvement of upper limbs and the face. Role of MRI is to exclude other causes. On MRI findings usually include thickening and enhancement of the nerve roots of the cauda equina. The lymphocytic and macrophagic infiltration around endoneural vessels with associated demyelination of the affected nerves is suggested mechanism behind this abnormal enhancement. Treatment options include supportive, immunoglobulin and plasmapharesis. Differential diagnosis: Normally nerve roots of cauda equina don’t enhance. Any enhancement considered as abnormal. Enhancement of cauda equina nerve roots is a nonspecific finding, suggests breakdown of the blood-nerve barrier due to any reason. DDs include: Acute inflammatory polyneuropathy. Chronic inflammatory demyelinating polyneuropathy. AIDS-related cytomegalovirus polyradiculopathy. Arachnoiditis. Granulomatous - Tuberculosis , Sarcoidosis. Infiltrating neoplastic disorders like lymphoma, metastasis. Transverse myelitis. Nerve root compression by herniated disc. Idiopathic - GBS.
Contributed By:
Dr Subramanian Ilanchezhian, Senior Resident, Sri Ramachandra Medical College, Chennai.
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