Presentation Title

Cervical Transverse Myelitis in a Patient with Guillain-Barré Syndrome, a New Variant Instead of a Coincidence?

Faculty Mentor

Jenna Gharzeddine, Antonio Liu

Start Date

17-11-2018 12:30 PM

End Date

17-11-2018 2:30 PM

Location

HARBESON 51

Session

POSTER 2

Type of Presentation

Poster

Subject Area

health_nutrition_clinical_science

Abstract

Guillain-Barré syndrome (GBS) is a rare disease affecting the peripheral nervous system, sparing the central nervous system. It presents as an ascending areflexic motor weakness, sparing sensation and lacks incontinence. Even rarer are the variants of GBS, such as Miller Fisher, Pharyngeal Cervical Brachial, and Bickerstaff’s Brainstem Encephalitis (BBE). BBE has brainstem involvement clinically and radiologically on MRI.

Alternatively, Transverse Myelitis (TM) is a spinal cord disease that spares the peripheral nervous system and causes spastic weakness with sensory loss and loss of bowel/bladder function. There are very few observations and publications of GBS and TM simultaneously affecting the same patient. Physicians approach these occurrences as “concomitant” and “coincidental.”

We present a case of a young female patient with typical ascending areflexic weakness consistent with GBS who also has high cervical and cervicomedullary junction findings on examination. She has urinary incontinence, sensory loss, and vertical nystagmus. GBS was confirmed by the presence of ganglioside antibodies and TM was confirmed by the presence of high spinal cord lesions on her MRI. The patient received treatment for GBS (plasma exchange) and TM (high dose corticosteroids) and subsequently experienced remarkable improvement prior to being transferred to long-term inpatient rehabilitation.

It is hypothesized that the observed simultaneous findings of GBS and TM are not coincidental; however, suggestive of a new GBS variant. Fewer than 30 reports document the co-existence of TM with GBS. It is proposed that this case adds to the collection of case reports that supports this new variant of GBS. Additional research may investigate the efficacy of employing immune modulation and corticosteroids in treating this variant. The utility in recognizing this proposed new variation of GBS would help guide management of these patients in the future and ultimately propagate better patient outcomes.

Keywords: Guillain-Barré, Cervical Transverse Myelitis, New Variant, Neurology

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Nov 17th, 12:30 PM Nov 17th, 2:30 PM

Cervical Transverse Myelitis in a Patient with Guillain-Barré Syndrome, a New Variant Instead of a Coincidence?

HARBESON 51

Guillain-Barré syndrome (GBS) is a rare disease affecting the peripheral nervous system, sparing the central nervous system. It presents as an ascending areflexic motor weakness, sparing sensation and lacks incontinence. Even rarer are the variants of GBS, such as Miller Fisher, Pharyngeal Cervical Brachial, and Bickerstaff’s Brainstem Encephalitis (BBE). BBE has brainstem involvement clinically and radiologically on MRI.

Alternatively, Transverse Myelitis (TM) is a spinal cord disease that spares the peripheral nervous system and causes spastic weakness with sensory loss and loss of bowel/bladder function. There are very few observations and publications of GBS and TM simultaneously affecting the same patient. Physicians approach these occurrences as “concomitant” and “coincidental.”

We present a case of a young female patient with typical ascending areflexic weakness consistent with GBS who also has high cervical and cervicomedullary junction findings on examination. She has urinary incontinence, sensory loss, and vertical nystagmus. GBS was confirmed by the presence of ganglioside antibodies and TM was confirmed by the presence of high spinal cord lesions on her MRI. The patient received treatment for GBS (plasma exchange) and TM (high dose corticosteroids) and subsequently experienced remarkable improvement prior to being transferred to long-term inpatient rehabilitation.

It is hypothesized that the observed simultaneous findings of GBS and TM are not coincidental; however, suggestive of a new GBS variant. Fewer than 30 reports document the co-existence of TM with GBS. It is proposed that this case adds to the collection of case reports that supports this new variant of GBS. Additional research may investigate the efficacy of employing immune modulation and corticosteroids in treating this variant. The utility in recognizing this proposed new variation of GBS would help guide management of these patients in the future and ultimately propagate better patient outcomes.

Keywords: Guillain-Barré, Cervical Transverse Myelitis, New Variant, Neurology