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Early axonal Guillain-Barré syndrome with normal peripheral conduction: imaging evidence for changes in proximal nerve segments
  1. José Berciano1,
  2. Elena Gallardo2,
  3. Pedro Orizaola3,
  4. Enrique Marco de Lucas2,
  5. Antonio García3,
  6. Ana L Pelayo-Negro1,
  7. María J Sedano1
  1. 1 Services of Neurology, University Hospital Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Universidad de Cantabria (UC) and Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
  2. 2 Department of Radiology, University Hospital Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Universidad de Cantabria (UC) and Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
  3. 3 Department of Clinical Neurophysiology, University Hospital Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Universidad de Cantabria (UC) and Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
  1. Correspondence to Dr José Berciano, Service of Neurology, University Hospital Marqués de Valdecilla (IDIVAL, UC and CIBERNED), Santander 39008, Spain; jaberciano{at}humv.es

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In early Guillain-Barré syndrome (GBS), including in its axonal forms, the most frequent electrophysiological findings are abnormalities of late responses (H reflex and F response) pointing to dysfunction in the proximal segments of the peripheral nerves.1 Ultrasonography and MRI are the imaging techniques of choice in any pathology of the peripheral nerve trunks.2 We report nerve imaging findings in a patient with early axonal GBS.

An 18-year-old woman was admitted with a 1-day history of lower limb weakness and calf myalgias. Two weeks prior, she had an episode of profuse diarrhoea of 4-day duration attended at home by her family physician; stool culture was not carried out. Initial examination revealed a waddling gait, weakness of proximal lower limb muscles mainly involving ilio-psoas (Medical Research Council grade 4/5), lower limb areflexia and absence of sensory loss. Upper limb reflexes were brisk. In the next few days the patient's lower limb weakness progressed, so that on day 6 after onset she was unable to walk, her muscle power being 2–3/5 proximally and 3–4/5 distally. Treatment with standard intravenous immunoglobulin (2 g/kg in 5 days) was administered. There has been progressive improvement; 3 months after onset, examination revealed mild waddling gait, paresis of hip abductors/flexors (3–4/5) and foot dorsiflexors (4/5), and lower limb areflexia. No serum IgG antiganglioside antibodies were detected. Campylobacter jejuni serology was not available. Cerebrospinal fluid showed a protein content of 70 mg/dL and no cells.

Sequential nerve conduction …

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