Ultrasonography of the peripheral nervous system in the early stage of Guillain‐Barré syndrome

Abstract

Ultrasonography can be used to visualize peripheral nerve abnormalities in immune-mediated neuropathies. The objective of this study was to prove the role of ultrasonography (US) in acute phase of Guillain-Barré syndrome (GBS). Systematic ultrasonic measurements of several peripheral nerves including the vagal nerve as well as the sixth cervical nerve root were performed in 18 patients with GBS at days 1-3 after symptom onset and compared to 21 healthy controls. Nerve conduction studies (NCS) of corresponding nerves were undertaken. Consequently, significant differences between the groups were found in compound muscle action potential amplitudes, F-wave latency, and persistency. Ultrasonic cross-sectional areas (CSAs) showed significant enlargement in all nerves except of the ulnar nerve (upper arm) and the sural nerve compared to healthy controls, most prominent in proximal and middle median nerve (p < 0.01). The vagal nerve also showed enlargement compared to controls (p < 0.05), which was most pronounced in patients with autonomic dysfunction compared to patients without (p < 0.05). C6 root diameter showed a significant correlation to the amount of cerebrospinal fluid (CSF)-protein (Pearson correlation, p < 0.05). US shows nerve enlargement in several peripheral nerves including vagal nerve and C6 root in acute phase of GBS and could be an additional diagnostic tool for example, in GBS of atypical onset and autonomic dysfunction.

Serial peripheral nerve ultrasound in Guillain–Barré syndrome

“…The changes were not at typical entrapment sites but at mid-arm in median nerve, ulnar wrist and mid-forearm, and sural nerve. These findings were in keeping with other studies (Zaidman et al, 2009;Gallardo et al, 2015b;Grimm et al, 2014). In two of these studies, patients were investigated at the acute stage (1-3 and within 10 days of onset).…”

“…Several studies have demonstrated that GBS patients have enlarged cervical roots at the acute stage (Gallardo et al, 2015b;Grimm et al, 2014Grimm et al, , 2015. In a recent study advocating the use of ''ultrasound pattern sum score'', the authors found that a subscore comprising of the fifth and sixth cervical roots was specific for diagnosis of GBS (Grimm et al, 2015) when compared to other chronic neuropathies such as chronic inflammatory demyelinating polyneuropathy and vasculitic neuropathies.…”

“…In GBS, there have been few studies that have investigated the role of peripheral nerve US (Zaidman et al, 2009;Almeida et al, 2012;Gallardo et al, 2015b;Grimm et al, 2014Grimm et al, , 2015Kerasnoudis et al, 2014a,b). Most have investigated the use of nerve US in the very early stages of GBS (Gallardo et al, 2015b;Grimm et al, 2014).…”

“…Most have investigated the use of nerve US in the very early stages of GBS (Gallardo et al, 2015b;Grimm et al, 2014). Nerves are seen to be enlarged in comparison to normal patients.…”

Ultrasound and electrophysiologic findings in patients with Guillain–Barré syndrome at disease onset and over a period of six months

“…In post-GBS patients patchy and slight enlargements have been reported (Kerasnoudis et al, 2013;Zaidman et al, 2009Zaidman et al, , 2013, whereas in acute stage cervical spinal nerve enlargement and hypertrophy of the vagus are probably the most obvious findings (Gallardo et al, 2014;Grimm et al, 2014d). However, only little is known about the course of nerve morphology from onset until clinical recovery.…”