Is it Guillain-Barré Syndrome with Extense Leptomenigeal Enhancement?

Abstract

184 Guillain-Barré syndrome (GBS), an acute immune-mediated polyneuropathy characterized by progressive ascending weakness and areflexia,1 occurs in both adult and pediatric populations, but is uncommon in children less than two years of age.1 Cerebrospinal fluid with albumincytological dissociation is a typical feature in GBS, and also a root enhancement may be seen on spinal cord images, obtained by magnetic resonance imaging (MRI).2 We report a case of a 5-months-old healthy infant, admitted to the Emergency Department in 2018, with decreased spontaneous movements of lower limbs, particularly in the left one, with less than 24 hours of evolution. Four days before, she had had a fever, associated with cough and rhinorrhea, without any causal agent having been identified (syncytial respiratory virus, influenza and adenovirus were tested), in a previous observation carried out in another hospital. Clinical examination showed a left lower limb paralysis, without pain on mobilization or inflammatory signs, and myotatic hyporeflexia in both lower limbs, being even more marked on the left. Based on the hypothesis of post-infectious radiculitis, a 1.5 Tesla MRI was performed under sedation (using a low dose of intravenous propofol and dexmedetomidine, maintaining spontaneous breathing), which showed diffuse leptomenigeal enhancement involving the entire height of the cord, surpassing the posterior fossa superiorly, until the cauda equina roots, which were thickened and enhancing after gadolinium administration (Figs. 1 and 2). Lumbar Informações/Informations: Imagem em Neurologia, publicado em Sinapse, Volume 22, Número 4, outubrodezembro 2022. Versão eletrónica em www.sinapse.pt; Image in Neurology, published in Sinapse, Volume 22, Number 4, October-December 2022. Electronic version in www.sinapse.pt © Autor (es) (ou seu (s) empregador (es)) e Sinapse 2022. Reutilização permitida de acordo com CC BY-NC. Nenhuma reutilização comercial. © Author(s) (or their employer(s)) and Sinapse 2022. Re-use permitted under CC BYNC. No commercial re-use.