545 - Overlapping Guillain-Barré Syndrome and Cervical Myelopathy

Case Diagnosis: Cervical Myelopathy, Guillain-Barré Syndrome

Case Description: The first case involves a 68-year-old man who presented with acute right hemiplegia. MRI cervical spine revealed moderate to severe stenosis with cord compression at C3-4 without cord signal abnormality, and MRI brain without acute stroke. He was scheduled for spinal surgery when he rapidly became tetraplegic with areflexia. A LP and EMG/NCS were performed and were consistent with Guillain-Barré Syndrome (GBS). Further history discovered he had a diarrheal illness shortly before his symptoms. The second case involves a 73-year-old female who presented with acute left radicular arm pain, hand clumsiness, left foot drop, brisk reflexes with MRI showing C3-7 stenosis with patchy cord signal abnormality and underwent cervical laminectomy. Post-operatively, she had progressive weakness with depressed reflexes which prompted MRI cervical spine showing post-op edema, LP and EMG/NCS consistent with GBS. Both patients were treated with IVIG and subsequently discharged to an acute inpatient rehabilitation facility and ultimately home.

Discussions: These two cases display rapidly progressive peripheral weakness that was initially thought to be due to spinal stenosis with surgical plans in place. They highlight both the need for thorough history and exam at admission, like reflexes, as they can guide differentials, but also the need for urgent treatment vs. differential diagnostic workup such as EMG/NCS. With the first case, his presentation was likely due to GBS, but the second case is less clear because there was an acute decline in her strength and depressed reflexes. With rapid deterioration, it is important to consider alternative diagnoses when the initial workup and treatment are not providing clinical improvements.

Conclusions: These cases provide evidence that acute motor polyneuropathies should be on the differential with spinal stenosis in patients presenting with rapidly progressive weakness, and further neurologic workup like EMG/NCS may be warranted acutely in patients presenting similarly.