J Korean Neurosurg Soc.  2013 Apr;53(4):245-248. 10.3340/jkns.2013.53.4.245.

Atypical Guillain-Barre Syndrome Misdiagnosed as Lumbar Spinal Stenosis

Affiliations
  • 1Department of Neurosurgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea. ktcho21@naver.com
  • 2Department of Emergency Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.

Abstract

Guillain-Barre syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy. In typical cases, the first symptoms of GBS are pain, numbness, paresthesia, weakness in the limbs. Autonomic involvement is common and causes urinary retention and ileus. Much of these symptoms overlap with those of lumbar spinal stenosis. Therefore, correct diagnosis of GBS in a patient with symptomatic lumbar spinal stenosis or in a patient with atypical manifestations of GBS can be difficult, especially early in the course of GBS. Here, we report on a case of atypical GBS in a 74-year-old previously healthy patient with lumbar spinal stenosis and discuss the differential diagnosis of the GBS and lumbar spinal stenosis.

Keyword

Guillain-Barre syndrome; Spinal stenosis; Polyradiculopathy

MeSH Terms

Diagnosis, Differential
Extremities
Guillain-Barre Syndrome
Humans
Hypesthesia
Ileus
Paresthesia
Polyradiculopathy
Spinal Stenosis
Urinary Retention

Figure

  • Fig. 1 Magnetic resonance imaging of the lumbar spine. A : Sagittal T2-weighted image shows lumbar spinal stenosis at L2-L3, L3-L4, and L4-L5 level. B : Axial T2-weighted image at L2-L3 level shows central canal stenosis and bilateral neural foraminal stenosis. C : Axial T2-weighted image at L3-L4 level shows central canal stenosis, bilateral neural foraminal stenosis, and disc herniation to the left side of the thecal sac. D : Axial T2-weighted image at L4-L5 level shows central canal stenosis and bilateral neural foraminal stenosis.

  • Fig. 2 Pre- and post-contrast enhancement magnetic resonance imaging of the lumbar spine. A : Pre-contrast enhancement sagittal T1-weighted image shows lumbar spinal stenosis at L2-L3, L3-L4, and L4-L5 level. B : Post-contrast enhancement sagittal T1-weighted image shows contrast enhancement in the cauda equina (white arrows).


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