Prognostic value of contrast-enhanced MRI in Guillain-Barré syndrome in children

Bacterial and Viral Infectious Disease of the Spine

Spinal infections are a diverse group of diseases affecting different compartments of the spine with variable clinical and imaging presentations. Diagnosis of spinal infections is based on a combination of clinical features, laboratory markers, and imaging studies. Imaging plays a pivotal role in the diagnosis and management of spinal infections. The characteristic imaging manifestations of bacterial and viral infections in the spine are discussed with key teaching points emphasized.

Radiologic grading scores enhance clinical model's prognostic ability for Guillain-Barré syndrome

OBJECTIVE

To assess the value of magnetic resonance imaging (MRI) grading scores based on lumbosacral muscle denervation edema in predicting the course of Guillain-Barré syndrome (GBS).

METHODS

We collected data from 354 GBS patients and developed MRI grading criteria (5-point scale) based on the transverse area and longitudinal length of lumbosacral edema. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with GBS prognosis among 12 demographic and radiological features. Clinical models and clinical-MRI models were separately trained and validated by data from Institution 1. External test was performed using data from Institution 2. Differences between the models were assessed using the z-test.

RESULTS

Four clinical factors (sex, albumin cytological dissociation in cerebrospinal fluid, medical research council [MRC] sum score at admission, and MRC sum score at discharge [odds ratio, 0.24-5.15; all p < 0.001]) and MRI grading scores (odds ratio, 2.44; p < 0.001) are independent prognostic factors for GBS patients. The shallow neural network achieved the best prognostic performance both clinical model (accuracy of external test cohort, 83.96%) and clinical-MRI model (accuracy of external test cohort, 90.56%). A significant difference between clinical and clinical-MRI model was also found (clinical model vs. clinical-MRI model, area under the receiver operating curve, 0.84 (95% CI: [0.71, 0.91]) vs. 0.97 (95% CI: [0.86, 0.99]), p < 0.001).

INTERPRETATION

The MRI grading scores for muscle denervation edema may serve as a potential prognostic risk factor for GBS. Furthermore, they significantly improve the prognostic performance of standalone clinical model in predicting GBS prognosis.

Adolescent Onset of Muscle Weakness

Pediatric adolescent muscle weakness can be from a variety of causes. Methodical diagnostic evaluation can lead to the category of diseases whereby phenotypic overlap requires either specialized care or broad testing patterns. However, having the ultimate diagnosis is important for prognostication.

Acute meningitis followed by Campylobacter jejuni associated Guillain-Barré Syndrome in a pediatric patient with COVID-19: a case report

Aim of the study: The association of GBS and meningitis in a pediatric population is infrequent. Given the limited number of reported cases from pediatric patients and considering that treatment guidelines are predominantly based on data gathered from adult patients; this is an opportunity to pay attention to different perspectives.Materials and methods: We present a case of a pediatric patient with a positive SARS-CoV2 test and acute meningitis followed by Campylobacter jejuni associated Guillain-Barré Syndrome.Results: To our knowledge, this is the first case of a pediatric patient presenting with the combination Guillain-Barré Syndrome following acute meningitis in the setting of a SARS-CoV2 infection.Conclusions: This case highlights the importance of recognizing vague and non-specific symptoms in pediatric patients, such as gait unsteadiness. Improving awareness of uncommon associations improves treatment and patient outcomes.

Case report: Incidence and prognostic value of brain MRI lesions and elevated cerebrospinal fluid protein in children with Guillain-Barré syndrome

Background

Guillain-Barrè syndrome (GBS) is an acute immune-mediated disorder affecting peripheral nerves and nerve roots with a variable clinical course and outcome. Epidemiologic analyses have revealed that the incidence of the syndrome increases linearly among the age. The clinical diagnosis of GBS is based on the family history, physical and neurological examination, electrodiagnostic exams, and cerebrospinal fluid analysis with the classical presence of albumin-cytologic dissociation. Prognosis is associated with the severity of clinical signs and the type of peripheral nerves involved.

Methods

This study aims to clarify which clinical features can be used for prognostic purposes. We evaluated the correlation between (1) brain MRI lesions and grade of disability; (2) brain MRI lesions and elevated cerebrospinal fluid (CSF) protein; and (3) increased levels of CSF protein and grade of disability. Statistical analysis extracted from these data indicated a good correlation to be a prognostic indicator in children affected by GBS. We found little evidence regarding laboratory tests, imaging, and prognosis. We enrolled 12 continuous patients who met the Brighton criteria for GBS in this retrospective study. Each patient was clinically evaluated at the time of disease onset to assess the GBS disability score and after 2 weeks.

Results

We estimated Pearson's correlation index to evaluate the possible correlation between MRI and disability and CSF protein levels and disability. The correlation coefficient was 0.92 and 0.85, respectively. In addition, we developed a graph to see the trend of the disability values, proteins in the CSF, and damage assessed with MRI in the 12 patients. It seems that these parameters have a parallel trend and a good correlation in each patient. Finally, we calculated the correlation between MRI and CSF protein values, with an r-value of 0.87. The values suggest a correlation among the MRI score, CSF protein, and prognosis.

Conclusion

The MRI and CSF laboratory parameters can be important tools for the clinician not only for diagnosis but also to evaluate the possible worsening of general conditions or the need to prepare measures to support life parameters. Patients who need ventilatory support could be established early from patients who have less severe GBS and can begin rehabilitation earlier. We suggest MRI should be performed routinely in children with GBS to be able to estimate the evolution of the clinical condition.

A Case of Acute Motor and Sensory Axonal Neuropathy Secondary to SGN-LIV1A Therapy

Antibody-drug conjugate therapy is rarely associated with neurologic immune-related phenomena. In this case report, we present a patient on treatment with SGN-LIV1A antibody-drug conjugate for breast cancer who developed progressive asymmetric quadriparesis, more severe in the bilateral upper extremities. Acute motor and sensory axonal neuropathy (AMSAN), a sub-variant of Guillain-Barré syndrome, was diagnosed via electro-diagnostic studies. Serological studies were significant for vitamin B1, B2 and B6 deficiencies, and cerebrospinal fluid studies were significant for albuminocytologic dissociation. The patient was treated with intravenous immunoglobulin (IVIg), B complex supplementation, and aggressive physical therapy. There was recovery of muscle strength in all extremities over the course of three months. Our case explores the biologic response to treatment of experimental immunotherapy-induced AMSAN with intravenous immunoglobulin.