Guillain-Barré syndrome following thoracic spinal cord trauma

Guillain-Barré syndrome (GBS) is an acute immunologic attack of the peripheral nerves causing rapidly ascending weakness and areflexia. Occasionally, weakness is severe enough to leave patients paralyzed and without adequate respiratory function. In such patients, intensive care unit (ICU) admission is required. Infrequently, GBS occurs in patients already admitted to the ICU. When this occurs, it can be difficult to distinguish GBS from critical illness neuropathy (CIN). However, it is important to consider GBS in these cases, since treatment options are available, and early treatment is associated with significantly improved outcome.

A 28-yr-old man involved in a motor vehicle collision sustained multiple injuries, including T6-T7 thoracic vertebrae fracture. Magnetic resonance imaging identified spinal cord compression at T6-T7, without brain or cervical cord injury. Shortly after admission, the patient developed marked autonomic instability with fluctuating temperatures and severe hypotension. Lower extremity weakness rapidly worsened to paraplegia and new weakness developed affecting bilateral upper extremities and face. Electrodiagnostic studies showed severe axonal polyneuropathy, with denervation in all extremities. The cerebrospinal fluid protein concentration was 5.03 g.L(-1). The patient was treated empirically for the possibility of GBS. Six months later, the patient recovered significant strength in his face and extremities, including his legs.

Guillain-Barré syndrome in trauma patients is rare and is limited to case reports following head trauma. This case also highlights the similarities and the subtle differences between GBS and CIN. Ultimately, definitive diagnosis of GBS may not be possible; however, an empiric course of intravenous immunoglobulins or plasma-exchange may be warranted, if GBS is a reasonable possibility.