Spinal nerve involvement in early Guillain–Barré syndrome: A clinico-electrophysiological, ultrasonographic and pathological study

•We carried out clinical-electrophysiological evaluation, and ultrasonography of peripheral nerves and cervical nerves in 6 early Guillain–Barré patients, with detailed autopsy study in one of them.•Involvement of spinal nerves was an outstanding finding.•Inflammatory oedema of spinal nerves is a pathogenically relevant feature to understanding the mechanism of ascending paralysis.

ObjectiveAlthough prevailing spinal nerve involvement has been recognized in a few detailed Guillain–Barré syndrome (GBS) autopsy reports, imaging studies addressing this question in cervical nerves are lacking.MethodsWe describe clinical, electrophysiological, ultrasonographic (US) and pathological findings in six consecutive early GBS patients, evaluated within 10 days of onset.ResultsPatients’ ages ranged from 37 to 80 years. Five patients required mechanical ventilation, two of them having died 9 and 28 days after onset. Upper- and lower-limb nerve US showed abnormal findings in just 8.8% of scanned peripheral nerves. In comparison with 46 aged-matched control subjects, US of the fifth to seventh cervical nerves showed changes in four cases, which consisted of significant nerve enlargement, blurred boundaries of the corresponding ventral rami, or both. Autopsy study in one case demonstrated that pathology, consisting of demyelination and endoneurial inflammatory oedema, mainly involved cervical and lumbar nerves.ConclusionsIn early GBS inflammatory oedema of spinal nerves is a pathogenically relevant feature to understanding the mechanism of ascending paralysis, particularly when conventional electrophysiological studies are normal or not diagnostic.SignificanceFindings advocate the use of cervical nerve US in early GBS.