High-frequency nerve ultrasound in Guillain-Barré syndrome

To explore the utility of high-frequency nerve ultrasound (HNUS) of peripheral nerves in patients with Guillain-Barré syndrome (pwGBS) at time of diagnosis and the following 6 months. Cross-sectional area (CSA) of brachial plexus nerves and upper limb peripheral nerves (20 sites total) were determined with HNUS in 21 pwGBS and 19 healthy subjects. PwGBS were examined 11 (median, interquartile range 6-14) days from motor symptom onset, with follow-up examinations 4 and 26 weeks later. Additionally, Medical Research Council sum-score and GBS Disability Score were assessed. At baseline, pwGBS had increased CSA at 16 out of 20 sites compared to healthy subjects. Sum-score of cervical roots C5-C7 decreased from baseline to 4 weeks (-0.042 (CI:-0.075; -0.008) cm2; p = 0.017) and further decreased to week 26 (-0.039 (CI: -0.067; -0.012) cm2; p = 0.008). In the interscalene passage, C5-C7 sum-score decreased from baseline to 26 weeks (-0.073 (CI: -0.127; -0.018) cm2; p = 0.012). Sum-score of proximal limb nerve CSA decreased from week 4 to week 26 (-0.038 (CI: -0.076; -0.001) cm2; p = 0.047). HNUS did not consistently correlate to clinical severity. HNUS enables detection of widespread acute nerve enlargements. Follow-up showed variable regression of nerve swellings at anatomical sites. HNUS may add information in diagnosis and monitoring of GBS.