Gallardo Elena, Sedano María J, Orizaola Pedro, Sánchez-Juan Pascual, González-Suárez Andrea, García Antonio, Terán-Villagrá Nuria, Ruiz-Soto María, Álvaro Rosa Landeras, Berciano María T, Lafarga Miguel, Berciano José
Service of Radiology, University Hospital "Marqués de Valdecilla", "Instituto de Investigación Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC) and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.
Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain.
Clin Neurophysiol. 2015 Apr;126(4):810-9. doi: 10.1016/j.clinph.2014.06.051. Epub 2014 Aug 21.
Although prevailing spinal nerve involvement has been recognized in a few detailed Guillain-Barré syndrome (GBS) autopsy reports, imaging studies addressing this question in cervical nerves are lacking.
We describe clinical, electrophysiological, ultrasonographic (US) and pathological findings in six consecutive early GBS patients, evaluated within 10 days of onset.
Patients' ages ranged from 37 to 80 years. Five patients required mechanical ventilation, two of them having died 9 and 28 days after onset. Upper- and lower-limb nerve US showed abnormal findings in just 8.8% of scanned peripheral nerves. In comparison with 46 aged-matched control subjects, US of the fifth to seventh cervical nerves showed changes in four cases, which consisted of significant nerve enlargement, blurred boundaries of the corresponding ventral rami, or both. Autopsy study in one case demonstrated that pathology, consisting of demyelination and endoneurial inflammatory oedema, mainly involved cervical and lumbar nerves.
In early GBS inflammatory oedema of spinal nerves is a pathogenically relevant feature to understanding the mechanism of ascending paralysis, particularly when conventional electrophysiological studies are normal or not diagnostic.
Findings advocate the use of cervical nerve US in early GBS.
尽管在一些详细的吉兰-巴雷综合征（GBS）尸检报告中已认识到存在普遍的脊神经受累情况，但缺乏针对颈神经这一问题的影像学研究。
我们描述了连续6例早期GBS患者的临床、电生理、超声（US）及病理结果，这些患者在发病10天内接受了评估。
患者年龄在37至80岁之间。5例患者需要机械通气，其中2例在发病后9天和28天死亡。上肢和下肢神经超声检查仅在8.8%的扫描外周神经中发现异常。与46名年龄匹配的对照受试者相比，第5至第7颈神经的超声检查在4例中显示有变化，表现为神经明显增粗、相应腹侧支边界模糊或两者皆有。1例尸检研究表明，病理表现为脱髓鞘和神经内膜炎性水肿，主要累及颈神经和腰神经。
在早期GBS中，脊神经的炎性水肿是理解上行性麻痹机制的一个与发病机制相关的特征，特别是当传统电生理研究正常或无法诊断时。
研究结果支持在早期GBS中使用颈神经超声检查。
