Spontaneous spinal epidural hematoma mimicking Guillain-Barre Syndrome

The initial symptoms of Guillain-Barre Syndrome (GBS) can be similar to a case of spontaneous spinal epidural hematoma (SSEH) located at the cervicothoracic junction. Therefore, SSEH may be misdiagnosed as GBS. Case Report: A previously healthy 6-year-old girl presented with a 2-day history of progr...

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Bibliographic Details
Published in:Brain & development (Tokyo. 1979) 2019-04, Vol.41 (4), p.392-395
Main Authors: Kondo, Aya, Yamaguchi, Hiroshi, Ishida, Yusuke, Toyoshima, Daisaku, Azumi, Mai, Akutsu, Nobuyuki, Koyama, Junji, Kurosawa, Hiroshi, Kawamura, Atushi, Maruyama, Azusa
Format: Article
Language:English
Subjects:
Albuminocytologic dissociation
Areflexia
Babinski sign
Cerebrospinal fluid
Child
Diagnostic Errors
Female
Guillain-Barre Syndrome
Guillain-Barre Syndrome - diagnosis
Hematoma, Epidural, Spinal - diagnosis
Humans
Magnetic Resonance Imaging
Muscle Weakness
Spinal Cord Compression - complications
Spinal shock
Spontaneous spinal epidural hematoma
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Summary:The initial symptoms of Guillain-Barre Syndrome (GBS) can be similar to a case of spontaneous spinal epidural hematoma (SSEH) located at the cervicothoracic junction. Therefore, SSEH may be misdiagnosed as GBS. Case Report: A previously healthy 6-year-old girl presented with a 2-day history of progressive pain in the lower extremities and an inability to walk. On initial evaluation, she was completely paraparetic in the lower extremities. Deep tendon reflexes were absent in the lower extremities, and Babinski reflexes were positive on both sides. She exhibited reduced response to light touch and pinprick with a sensory level below T10, and experienced difficulty during urination. However, the strength, sensation and flexion of upper extremities were normal. Because her presentation and examinations were consistent with GBS, we initiated intravenous immunoglobulin therapy. The next day, she also developed pain and muscle weakness of the right upper extremity. Three days after admission, respiratory depression progressed rapidly. Spinal MRI showed a mass extending from the level of C7-T3, with spinal cord compression. The patient underwent an emergency laminectomy with evacuation of hematoma, and was diagnosed with SSEH. Sixty days after admission, she was transferred to the rehabilitation hospital with severe neurologic sequelae of paralysis in both legs. Conclusion: SSEH might have severe consequences, including neurologic deficits and risk of death. This case report serves to raise the awareness of SSEH that mimics the initial presentation of GBS.
ISSN:0387-7604
1872-7131
DOI:10.1016/j.braindev.2018.11.004