Sural-sparing is seen in axonal as well as demyelinating forms of Guillain-Barré syndrome.

Abstract

OBJECTIVE:

The "sural-sparing pattern" of Guillain-Barré syndrome (GBS) is believed to reflect demyelinating pathology. We asked if it is present in non-demyelinating GBS-subtypes, namely acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN) and Miller Fisher syndrome (MFS), in addition to acute inflammatory demyelinating polyneuropathy (AIDP).

METHODS:

We studied the occurrence of sural-sparing pattern in clinically defined GBS and MFS patients. Using serial electrodiagnostic studies, GBS patients were divided into AIDP, according to appearance of demyelination-remyelination and AMAN/AMSAN, if there were signs of reversible conduction failure or Wallerian-like degeneration. Equivocal cases were left unclassified. We defined sural-sparing as a greater decrease in median and or ulnar sensory nerve action potential than that of the sural, compared to age and height-matched normal controls.

RESULTS:

Twelve of 30 GBS and 7 of 20 MFS patients had sural-sparing. This pattern was seen in 4 of 8 AIDP, 5 of 13 AMAN/AMSAN and 3 of 9 unclassified cases. Sequential studies uncovered sural-sparing, initially covert, in additional 1 MFS, 1 unclassified, 1 AIDP and 1 AMAN/AMSAN patient.

CONCLUSIONS:

Sural-sparing occurs in axonal and demyelinating GBS subtypes.

SIGNIFICANCE:

The sural-sparing pattern reflects a pathological process common to axonal and demyelinating GBS-subtypes alike.

• Authors: Thirugnanam Umapathi, Zongbin Li, Kamal Verma, Nobuhiro Yuki
• Journal: Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology (Clin Neurophysiol) Vol. 126 Issue 12 Pg. 2376-80 (Dec 2015) ISSN: 1872-8952 [Electronic] Netherlands
• PMID: 25743269 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Axons (physiology)
• Demyelinating Diseases (diagnosis, physiopathology)
• Female
• Guillain-Barre Syndrome (diagnosis, physiopathology)
• Humans
• Male
• Middle Aged
• Miller Fisher Syndrome (diagnosis, physiopathology)
• Sural Nerve (physiopathology)
• Young Adult