Umapathi Thirugnanam, Koh Jasmine S, Cheng Y J, Goh Eunice J H, Lim Christen S J
National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore 308433, Singapore.
Clin Neurophysiol Pract. 2020 Feb 7;5:43-45. doi: 10.1016/j.cnp.2019.12.002. eCollection 2020.
We present an exemplar patient, illustrating utility of the sural-sparing pattern in diagnosis of Guillain-Barré Syndrome (GBS). We then present data that sheds light on the pathophysiology of sural-sparing.
We describe a case of complex ophthalmoplegia that exemplifies the challenge of diagnosing regional subtypes of Guillain-Barré Syndrome, and the value of scrutinizing sensory nerve action potentials for the sural-sparing pattern. We also demonstrate, in a series of GBS patients, how serial nerve conduction studies can reveal "covert" sural-sparing in patients without sural-sparing on the initial study. Finally, by studying the median and radial sensory nerve action potentials at digit I in GBS patients, we demonstrate that the likely pathology of sural-sparing is related to the predilection of median nerve for subclinical entrapment; where the blood-nerve barrier is deficient and therefore more exposed to the immunopathology of GBS.
Incorporating sural-sparing would improve the specificity of GBS electrodiagnosis; especially in difficult to diagnose regional subtypes of GBS.
我们展示了一个典型病例，说明了保留腓肠神经模式在吉兰 - 巴雷综合征（GBS）诊断中的作用。然后我们展示了有助于阐明保留腓肠神经病理生理学的数据。
我们描述了一例复杂眼肌麻痹病例，该病例体现了诊断吉兰 - 巴雷综合征局部亚型的挑战，以及仔细检查感觉神经动作电位以发现保留腓肠神经模式的价值。我们还在一系列GBS患者中证明，系列神经传导研究如何能揭示初始研究时未出现保留腓肠神经的患者存在“隐匿性”保留腓肠神经的情况。最后，通过研究GBS患者示指的正中神经和桡神经感觉神经动作电位，我们证明保留腓肠神经可能的病理与正中神经易发生亚临床卡压有关；在血 - 神经屏障存在缺陷的部位，因此更容易受到GBS免疫病理的影响。
纳入保留腓肠神经的情况将提高GBS电诊断的特异性；尤其是在难以诊断的GBS局部亚型中。
