Guillain-Barre Syndrome Mimicked by Spinal Stenosis in A Case of Chronic Prolapsed Intervertebral Disc: A Case Report
DOI:
https://doi.org/10.5195/ijms.2023.1603Keywords:
Guillain-Barre Syndrome, Polyradiculoneuropathy, Intervertebral Disc Displacement, Spinal StenosisAbstract
Background: Guillain-Barre Syndrome (GBS) is a rare acute autoimmune polyneuropathy, usually preceded by infections. It can be difficult to diagnose, especially in patients with underlying neurological comorbidities.
Case: A 54-year-old male, with a long history of a prolapsed intervertebral disc, presented with progressive and asymmetrical onset tetraparesthesia for 4 weeks, which was associated with progressive paraparesis for 2 weeks. The diagnosis of GBS was initially missed due to a lack of relevant history of prior infection, atypical presentation (asymmetrical limb weakness), and radiological evidence of spinal stenosis. Nerve conduction study, cerebrospinal fluid analysis, and antiganglioside antibodies later confirmed the diagnosis of GBS. The patient was started on intravenous immunoglobulin and achieved significant improvement. He was discharged a week later and transferred to a rehabilitation hospital.
Conclusion: GBS should not be excluded prior to diagnostic tests and lab work in neurological patients. Physicians should avoid over-reliance on radiological findings to conclude a diagnosis. Comprehensive history and examinations to understand the development of patients' presentations should be prioritized when establishing a diagnosis.
Metrics
References
Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahi M. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-22. DOI: https://doi.org/10.1016/S0140-6736(20)30925-9
Willison HJ, Jacobs BC, Doorn PA van. Guillain-Barré syndrome. Lancet. 2016;388(10045):717–27. DOI: https://doi.org/10.1016/S0140-6736(16)00339-1
Bragazzi NL, Kolahi AA, Nejadghaderi SA, Lochner P, Brigo F, Naldi A, et al. Global, regional, and national burden of Guillain–Barré syndrome and its underlying causes from 1990 to 2019. J Neuroinflammation. 2021;18(1):264. DOI: https://doi.org/10.1186/s12974-021-02319-4
Piccione EA, Salame K, Katirji B. Guillain-Barré Syndrome and Related Disorders. In: Katirji B, Kaminski HJ, Ruff RL (eds.) Neuromuscular Disorders in Clinical Practice. Springer, New York; 2014. p. 573–603. DOI: https://doi.org/10.1007/978-1-4614-6567-6_28
Alvarez JA, Hardy RH. Lumbar spine stenosis: a common cause of back and leg pain. Am Fam Physician. 1998;57(8):1825–34, 1839–40.
Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022;327(17):1688–99. DOI: https://doi.org/10.1001/jama.2022.5921
Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain–Barré syndrome in ten steps. Nat Rev Neurol. 2019;15(11):671–83. DOI: https://doi.org/10.1038/s41582-019-0250-9
van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 2014;10(8):469–82. DOI: https://doi.org/10.1038/nrneurol.2014.121
Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27(S1):S21–4. DOI: https://doi.org/10.1002/ana.410270707
Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain. 2014;137(1):33–43. DOI: https://doi.org/10.1093/brain/awt285
Sejvar JJ, Kohl KS, Gidudu J, Amato A, Bakshi N, Baxter R, et al. Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine. 2011;29(3):599–612. DOI: https://doi.org/10.1016/j.vaccine.2010.06.003
Finley CR, Chan DS, Garrison S, Korownyk C, Kolber MR, Campbell S, Eurich DT, Lindblad AJ, Vandermeer B, Allan GM. What are the most common conditions in primary care? Systematic review. Can Fam Physician. 2018;64(11):832-840.
Walgaard C, Lingsma HF, Ruts L, van Doorn PA, Steyerberg EW, Jacobs BC. Early recognition of poor prognosis in Guillain-Barre syndrome. Neurology. 2011;76(11):968-75. DOI: https://doi.org/10.1212/WNL.0b013e3182104407
Doets AY, Lingsma HF, Walgaard C, Islam B, Papri N, Davidson A, et al. Predicting Outcome in Guillain-Barré Syndrome: International Validation of the Modified Erasmus GBS Outcome Score. Neurology. 2022;98(5):e518-e532.
Walgaard C, Jacobs BC, Lingsma HF, Steyerberg EW, van den Berg B, Doets AY, et al. Second intravenous immunoglobulin dose in patients with Guillain-Barré syndrome with poor prognosis (SID-GBS): a double-blind, randomised, placebo-controlled trial. Lancet Neurol. 2021;20(4):275-283. DOI: https://doi.org/10.1016/S1474-4422(20)30494-4
Jacobs BC, van den Berg B, Verboon C, Chavada G, Cornblath DR, Gorson KC, et al. International Guillain-Barré Syndrome Outcome Study: protocol of a prospective observational cohort study on clinical and biological predictors of disease course and outcome in Guillain-Barré syndrome. J Peripher Nerv Syst. 2017;22(2):68-76. DOI: https://doi.org/10.1111/jns.12209
Published
How to Cite
License
Copyright (c) 2023 Yi Xuan Lee
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org