Abstract
Objective: Many patients being investigated for Guillain-Barré syndrome
(GBS) undergo unnecessary neuroimaging with magnetic resonance imaging
(MRI) or computed tomography (CT). The objective of this study was to
determine the proportion of patients with GBS undergoing neuroimaging
investigation, and investigate any association with different GBS
variants, and the level of certainty using the Brighton Criteria.
Methods: A single-center observational study was conducted in Pakistan’s
leading tertiary care hospital, that enrolled 148 patients being
investigated for, and subsequently diagnosed with GBS between January
2017 and March 2020. Participants were asked if they had undergone
neuroimaging of the craniospinal axis before or during hospital
admission, and the purpose of any CT scan. We enquired whether
fundoscopy had been performed before lumbar puncture and determined the
level of certainty based on the Brighton Criteria. Results: The majority
of participants were male (n=107; 73%), with a mean± SD age of
42.85±18.4 years. The mean waiting time to their first interaction with
a neurologist was 5.2±4.01 days, and the demyelinating variant of GBS
was more common than the axonal variant (1.6:1). Most patients were
diagnosed with level I certainty using the Brighton criteria (n=113;
76%). MRI brain and spine were performed ahead of admission in 48
(32%) and 59 (39%) patients, respectively. CT scan brain was performed
in 121 (82%) patients before lumbar puncture while 27 (18%) only
underwent fundoscopic examination before lumbar puncture. Conclusion:
Clinical examination is fundamental in the diagnosis of GBS.
Neuroimaging may be inappropriate and unnecessary, and detract attention
from crucial peripheral neuropathy measures while misusing limited
resources. Keywords: Guillian Barre Syndrome; Neuroimaging; Brighton
Criteria