title: Sural sparing in Guillain-Barré syndrome subtypes: a reappraisal with historical and recent definitions.
abstract: OBJECTIVE
  To ascertain the impact of definition and diagnostic criteria on sural sparing in Guillain-Barré syndrome (GBS).
  
  
  METHODS
  We retrospectively reviewed records of 78 consecutive patients with GBS from Birmingham, UK (2001-2012) studied within 21 days post-onset. Different criteria were initially used for subtype classification. Sural sparing was subsequently ascertained using historical/recent definitions.
  
  
  RESULTS
  With Hadden et al.'s criteria, "absent median present sural" and "absent median normal sural" patterns offered sensitivities of 21.7% and 15.2% respectively for AIDP, with specificities of 100% versus axonal GBS. Present sural with two abnormal upper limb responses had a sensitivity of 19.1% and 100% specificity. "Abnormal radial present sural" and "abnormal radial normal sural" patterns had sensitivities of 18.9% and 16.2% and specificity of 100%. With newly-proposed criteria (Rajabally et al., 2015), "absent median present sural" and "absent median normal sural" patterns offered sensitivities of 27.8% and 19.4% respectively, with specificity of 100%. Ulnar patterns were unhelpful with both criteria. Other patterns had suboptimal specificity.
  
  
  CONCLUSIONS
  Although of low sensitivity, sural sparing defined by absent median/present sural patterns, is specific of AIDP versus axonal GBS, irrespective of criteria.
  
  
  CONCLUSIONS
  Sural sparing is definition and criteria-dependent in GBS but is specific of AIDP with historical definitions, regardless of criteria.
authors.affiliation: Regional Neuromuscular Clinic, Queen Elizabeth Hospital, University Hospitals of Birmingham, Birmingham, UK.
authors.forename: Fu Liong
authors.initials: FL
authors.lastname: Hiew
authors.affiliation: Regional Neuromuscular Clinic, Queen Elizabeth Hospital, University Hospitals of Birmingham, Birmingham, UK. Electronic address: Yusuf.Rajabally@uhb.nhs.uk.
authors.forename: Yusuf A
authors.initials: YA
authors.lastname: Rajabally
mesh_terms: D000328:Adult; D000368:Aged; D004568:Electrodiagnosis / Q000379:methods; D005260:Female; D020275:Guillain-Barre Syndrome / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology*; D012189:Retrospective Studies; D013497:Sural Nerve / Q000502:physiology*
keywords: Acute inflammatory demyelinating polyradiculoneuropathy; Axonal; Electrophysiology; Guillain–Barré syndrome; Median; Radial; Sparing; Sural; Ulnar