title: Spinal nerve involvement in early Guillain-Barré syndrome: a clinico-electrophysiological, ultrasonographic and pathological study.
abstract: OBJECTIVE
  Although prevailing spinal nerve involvement has been recognized in a few detailed Guillain-Barré syndrome (GBS) autopsy reports, imaging studies addressing this question in cervical nerves are lacking.
  
  
  METHODS
  We describe clinical, electrophysiological, ultrasonographic (US) and pathological findings in six consecutive early GBS patients, evaluated within 10 days of onset.
  
  
  RESULTS
  Patients' ages ranged from 37 to 80 years. Five patients required mechanical ventilation, two of them having died 9 and 28 days after onset. Upper- and lower-limb nerve US showed abnormal findings in just 8.8% of scanned peripheral nerves. In comparison with 46 aged-matched control subjects, US of the fifth to seventh cervical nerves showed changes in four cases, which consisted of significant nerve enlargement, blurred boundaries of the corresponding ventral rami, or both. Autopsy study in one case demonstrated that pathology, consisting of demyelination and endoneurial inflammatory oedema, mainly involved cervical and lumbar nerves.
  
  
  CONCLUSIONS
  In early GBS inflammatory oedema of spinal nerves is a pathogenically relevant feature to understanding the mechanism of ascending paralysis, particularly when conventional electrophysiological studies are normal or not diagnostic.
  
  
  CONCLUSIONS
  Findings advocate the use of cervical nerve US in early GBS.
authors.affiliation: Service of Radiology, University Hospital "Marqués de Valdecilla", "Instituto de Investigación Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC) and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Gallardo
authors.affiliation: Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Sedano
authors.affiliation: Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Orizaola
authors.affiliation: Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain.
authors.forename: Pascual
authors.initials: P
authors.lastname: Sánchez-Juan
authors.affiliation: Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: González-Suárez
authors.affiliation: Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: García
authors.affiliation: Service of Pathology, University Hospital "Marqués de Valdecilla", Santander, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Terán-Villagrá
authors.affiliation: Department of Anatomy and Cell Biology, UC, IDIVAL and CIBERNED, Santander, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Ruiz-Soto
authors.affiliation: Service of Radiology, University Hospital "Marqués de Valdecilla", "Instituto de Investigación Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC) and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.
authors.forename: Rosa Landeras
authors.initials: RL
authors.lastname: Álvaro
authors.affiliation: Department of Anatomy and Cell Biology, UC, IDIVAL and CIBERNED, Santander, Spain.
authors.forename: María T
authors.initials: MT
authors.lastname: Berciano
authors.affiliation: Department of Anatomy and Cell Biology, UC, IDIVAL and CIBERNED, Santander, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Lafarga
authors.affiliation: Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain. Electronic address: jaberciano@humv.es.
authors.forename: José
authors.initials: J
authors.lastname: Berciano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D055724:Electrophysiological Phenomena / Q000502:physiology; D005260:Female; D020275:Guillain-Barre Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013127:Spinal Nerves / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D014463:Ultrasonography
keywords: AIDP; AMAN; AMSAN; Antiganglioside antibody; Axonal degeneration; Demyelination; Electrophysiology; Endoneurial oedema; Experimental allergic neuritis; Guillain–Barré syndrome; Methylprednisolone; Ultrasonography