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This was a child who had an antecedent viral infection

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and presented with lower extremity weakness and saddle

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anesthesia, effectively a cauda equina syndrome.

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The imaging of the brain was normal.

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The imaging on the non contrast scans,

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which I'll show eventually was, also normal.

0:24

And then we got to the post gadolinium-enhanced scan.

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So on this child,

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we look at the contrast enhanced images of the cervical

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and upper thoracic region, and this is...

0:35

I would pass this.

0:37

This is basically normal vascularity that you see on the

0:41

surface of the spinal cord and no enhancement

0:44

in the spinal cord. However,

0:45

when we get to the thoracolumbar junction,

0:47

all of a sudden, we start seeing this enhancement on the

0:51

surface of the conus medullaris extending

0:54

into the cauda equina nerve roots.

0:57

So what I'm looking at is the bright signal intensity

1:00

enhancement on the surface of the spinal cord.

1:03

So this is outside the spinal cord, therefore,

1:06

intradural extramedullary.

1:08

And then we have the cauda equina nerve roots,

1:10

which are clumped together and are

1:13

showing prominent enhancement.

1:15

If we look at the axial scans through the cauda equina

1:19

nerve roots, we see them all diffusely enhancing.

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Now, one point to be made is that the nerve roots

1:26

do not appear to be enlarged.

1:28

So remember

1:29

in the past, we've seen cases of neurofibromatosis,

1:32

in which we saw schwannomas and neurofibromas of the

1:36

nerve roots, and that assumed an enlarged

1:39

nerve root appearance.

1:40

Here, in this patient who has Guillain-Barre syndrome,

1:44

the nerve roots are not enlarged,

1:46

but they are diffusely enhancing.

1:48

And just to make sure that we're all agreed,

1:51

here is the post gadolinium enhanced scan through the

1:54

brain showing no enhancement or abnormality. On the

1:59

spinal evaluation on T2-weighted scans,

2:03

you're seeing flow artifacts of prominent CSF flow,

2:07

but no abnormalities in the spinal cord, and nothing that

2:11

can be really determined on the cauda equina nerve root

2:16

evaluation on T2 weighted imaging.

2:18

So this is almost a purely post gadolinium diagnosis

2:22

that is made. In this case Guillain-Barre syndrome.