Lower limb and back pain in Guillain-Barré syndrome and associated contrast enhancement in MRI of the cauda equina.
This study assesses the frequency of lower limb and back pain in children with Guillain-Barré syndrome and reviews the magnetic resonance imaging results of those undergoing spinal imaging. Over an 8-y period, nine children presented with various combinations of severe back pain, leg pains, impairment of gait and bladder dysfunction. Guillain-Barré syndrome was confirmed on clinical examination and peripheral electrophysiology (n = 8). Magnetic resonance imaging in four patients, following contrast injection, showed enhancement of the cauda equine and, additionally, of the cervical nerve roots in one of the patients. A further patient, who was not scanned with contrast, had abnormal thickening of the lumbar roots. Carbamazepine and steroids were effectively used for analgesia in three cases. All the patients recovered.


CONCLUSIONS
Guillain-Barré syndrome should be considered in the differential diagnosis of children presenting with back and/or leg pain. Early diagnosis ensures prompt monitoring for autonomic dysfunction and respiratory compromise.
Wilmshurst
J M
JM
Department of Paediatric Neurology, Newcomen Centre, Guy's Hospital, London, UK. mhjmw@mweb.co.za
Thomas
N H
NH
Robinson
R O
RO
Bingham
J B
JB
Pohl
K R
KR
D001416:Back Pain / Q000209:etiology*; D002420:Cauda Equina / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007866:Leg; D008279:Magnetic Resonance Imaging; D010146:Pain / Q000209:etiology*