Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1096
Peer-review started: July 25, 2020
First decision: November 26, 2020
Revised: December 10, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: February 16, 2021
Processing time: 188 Days and 20.2 Hours
Guillain-Barré syndrome (GBS) is a rare disorder that typically presents with ascending weakness, pain, paraesthesias, and numbness, which mimic the findings in lumbar spinal stenosis. Here, we report a case of severe lumbar spinal stenosis combined with GBS.
A 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness. Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis. However, his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness. An electromyogram was performed. Based on his symptoms, physical examination, and electromyogram, he was diagnosed with GBS. After 5 d of intravenous immunoglobulin (0.4 g/kg/d for 5 d) therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up.
GBS should be considered in the differential diagnosis of spinal disorder, even though magnetic resonance imaging shows severe lumbar spinal stenosis. This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.
Core Tip: A 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department because of severe lower back pain and lower extremity numbness. On the physical examination, he had 4/5 of strength in both legs and decreased sensation below the knees. Magnetic resonance imaging demonstrated lumbar spinal stenosis (L4/5). Based on these findings, he was diagnosed with lumbar spinal stenosis. After conservative treatment failed, he underwent transforaminal lumbar interbody fusion. However, his symptoms worsened postoperatively and dysphagia appeared. An electromyogram was performed. Finally, he was diagnosed with Guillain-Barré syndrome. After 5 d of intravenous immunoglobulin therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. This case demonstrates that Guillain-Barré syndrome should be considered in the differential diagnosis of spinal disorder and highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.