Teaching Neuroimages: Variant Of Guillain-Barre Syndrome With Spinal Cord Involvement

A 48-year-old man presented with ascending sensory deficits over 12 hours, followed by urinary retention. He had areflexia, mild lower extremity weakness, sensory ataxia, and a T2 sensory level. Smooth pursuit was impaired, but cranial nerves were otherwise normal. Diagnostic evaluation demonstrated CSF cytoalbuminologic dissociation and demyelinating polyneuropathy fulfilling the electrodiagnostic criteria for Guillain-Barre syndrome (GBS).(1) Laboratory evaluation had normal results, including vitamin B-12; anti-neuromyelitis optica, antineuronal, and ganglioside antibodies; and oligoclonal bands. Myelopathy was confirmed on MRI (figure). This case highlights that acquired acute demyelination may rarely affect the peripheral and CNS simultaneously (GBS-transverse myelitis overlap syndrome), likely related to common autoimmune-mediated pathomechanisms.(2更多