Childhood Guillain-Barre syndrome -: MR imaging in diagnosis and follow-up

Purpose: To evaluate the value of serially obtained spinal MR images in the diagnosis and clinical follow-up of childhood Guillain-Barre syndrome (GBS), and the time period for resolution of contrast enhancement during the course of illness. Material and Methods: Contrast-enhanced spinal MR images of 11 pediatric patients with GBS were reviewed prospectively. In the first group of 6 patients, follow-up MR was performed three times after the 1st, 3rd and 6th months after onset of the disease. In the second group (the other 5 patients) who had not accepted serial MR examinations, control MR was repeated once after 1 year. Patients were graded clinically into five categories according to their initial clinical signs and symptoms and three grades (mild, moderate and severe) according to level of contrast enhancement on T1-weighted images to correlate the severity of enhancement with clinical findings and recovery. Results: Ten of the 11 patients revealed contrast enhancement in varying degrees in the spinal nerve roots surrounding the conus medullaris and extending the length of the cauda equina. One patient showed no contrast enhancement. Anterior nerve roots enhanced more intensely than the posterior roots in 3 patients. Follow-up MR images in all patients revealed diminishing or resolving contrast enhancement in the nerve roots as the clinical symptoms improved. Conclusion: We suggest contrast-enhanced spinal MR imaging as a supplementary diagnostic modality in diagnosing GBS, especially when the clinical and electrophysiological findings are equivocal. Follow-up images may play a role in predicting the clinical course of the disease.