Gorson K C, Ropper A H, Muriello M A, Blair R
Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
Neurology. 1996 Sep;47(3):813-7. doi: 10.1212/wnl.47.3.813.
Nerve root enhancement of the cauda equina occurs in Guillain-Barré syndrome (GBS), but the frequency, diagnostic value, and meaning of this finding is unknown. We prospectively obtained gadolinium-enhanced lumbosacral spine MRIs in 24 consecutive patients with acute GBS and blindly rated nerve root enhancement as absent, mild, or prominent. The MRIs were obtained 13 days, mean, after onset of symptoms (range 2 to 42 days). Twenty of 24 patients had cauda equina nerve root enhancement, which was mild in 6 and prominent in 14. Eighteen of 19 with "typical" GBS had enhancement, compared with 2 of 5 with a variant presentation. Sixty percent of patients with prominent enhancement had severe back or leg pain in contrast to 10% of patients with mild or no enhancement. The GBS disability grade (0 to 5 scale) was higher in patients with prominent enhancement, and significantly fewer patients with prominent nerve root enhancement could walk independently by 2 months. There was no relationship between nerve root enhancement and the timing of the MRI, CSF protein, any of several EMG abnormalities, duration of hospitalization, mean disability grade at 2 months, or the time required for patients to improve to grade 2. In two patients, the EMGs at 11 and 20 days, respectively, were normal except for slightly prolonged F-responses and neurogenic recruitment, but there were prominent nerve root enhancement and an elevated CSF protein. Enhancement of the cauda equina nerve roots with gadolinium on lumbosacral MRI is 83% sensitive of acute GBS and was present in 95% of typical cases. This finding may be useful when electrophysiologic abnormalities are equivocal. In addition, conspicuous nerve root enhancement correlates with pain, GBS disability grade, and duration of recovery.
马尾神经根强化见于吉兰-巴雷综合征（GBS），但这一发现的发生率、诊断价值及意义尚不清楚。我们前瞻性地对24例连续的急性GBS患者进行了钆增强腰骶部脊柱MRI检查，并在不知情的情况下将神经根强化分为无、轻度或显著。MRI检查在症状出现后平均13天（范围2至42天）进行。24例患者中有20例存在马尾神经根强化，其中6例为轻度，14例为显著。19例“典型”GBS患者中有18例有强化，而5例变异型表现患者中有2例有强化。显著强化的患者中有60%有严重的背部或腿部疼痛，而轻度强化或无强化的患者中这一比例为10%。显著强化患者的GBS残疾分级（0至5级）更高，且显著强化的患者中在2个月时能够独立行走的人数明显更少。神经根强化与MRI检查时间、脑脊液蛋白、几种肌电图异常中的任何一种、住院时间、2个月时的平均残疾分级或患者改善至2级所需时间均无关联。在2例患者中，分别在第11天和第20天进行的肌电图检查除F波反应略延长和神经源性募集外均正常，但存在显著的神经根强化和脑脊液蛋白升高。腰骶部MRI上钆增强显示马尾神经根强化对急性GBS的敏感性为83%，在95%的典型病例中存在。当电生理异常不明确时，这一发现可能有用。此外，明显的神经根强化与疼痛、GBS残疾分级及恢复时间相关。
