title: Ultrasound and electrophysiologic findings in patients with Guillain-Barré syndrome at disease onset and over a period of six months.
abstract: OBJECTIVE
  To investigate cross-sectional areas (CSAs) of several peripheral nerves including the vagus nerve and the diameter of spinal nerves as measured by nerve ultrasound (NUS) and nerve conduction studies (NCS) in Guillain-Barré syndrome (GBS) patients over at least six months compared to healthy controls.
  
  
  METHODS
  NUS and/or NCS of several nerves, the vagus nerve, and the 5th/6th cervical spinal nerves were performed in patients with GBS at days 2-3 after symptom onset, at days 10-14 after immunoglobulin therapy and after six months compared to healthy controls.
  
  
  RESULTS
  27 GBS-patients and 31 controls were included. Using NUS significant enlargement was found in all measured nerves (P<0.001), except the sural nerve (P=0.086) compared to the controls at onset. The vagus (median 3.0 mm(2) vs. 2.0 mm(2), P<0.0001) and the cervical spinal nerves were significantly enlarged (median 3.5/4.0 mm vs. 2.6/3.2 mm, p<0.0001), the vagus most obviously in patients with autonomic dysregulation (AD, 4.0 mm(2)). Six months later, NCS showed persisting pathology in CMAP-amplitudes with amelioration of F-wave pathology. NUS showed restitution in the spinal nerves (median 2.6/3.2 mm) and the vagus (median 2.0 mm(2)) in all patients excluding the vagus in those with persistent AD (median 4.0 mm(2)). The peripheral nerves did not change significantly (P>0.05).
  
  
  CONCLUSIONS
  Ultrasonographic detection of cervical spinal nerve enlargement supports the diagnosis of GBS in the early phase. Its regression may be a good parameter for the clinical restitution over time. Vagus enlargement may be a risk marker for development of AD.
  
  
  CONCLUSIONS
  Ultrasound is a reliable diagnostic follow-up tool in early GBS.
authors.affiliation: Department of Neurology, Basel University Hospital, Basel, Switzerland; Department of Neurology, University of Tuebingen, Tuebingen, Germany. Electronic address: alexander.grimm@usb.ch.
authors.forename: Alexander
authors.initials: A
authors.lastname: Grimm
authors.affiliation: Department of Neurology, Basel University Hospital, Basel, Switzerland.
authors.forename: Bernhard F
authors.initials: BF
authors.lastname: Décard
authors.affiliation: Department of Neurology, Erlangen University Hospital, Erlangen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Schramm
authors.affiliation: Department of Neurology, Basel University Hospital, Basel, Switzerland.
authors.forename: Anne-Katrin
authors.initials: AK
authors.lastname: Pröbstel
authors.affiliation: Department of Neurology, Basel University Hospital, Basel, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Rasenack
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Axer
authors.affiliation: Department of Neurology, Basel University Hospital, Basel, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Fuhr
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D042241:Early Diagnosis; D055724:Electrophysiological Phenomena / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D020275:Guillain-Barre Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology*; D010525:Peripheral Nerves / Q000000981:diagnostic imaging / Q000502:physiology; D013997:Time Factors; D014463:Ultrasonography
keywords: Guillain–Barré syndrome; Immune-mediated neuropathy; Nerve ultrasonography; Spinal nerves; Vagus nerve