Flaccid paralysis + hyporeflexia w/ h/o URI = Guillain-Barre $
However, a sensory level and bowel/bladder dysfunction after URI make transverse myelitis (TM) more likely.
Flaccid paralysis and hyporeflexia are common in early stages of myelopathy (spinal shock).
order immediate MRI (spine)
Steroids should be administered after the diagnosis is established with MRI or empirically if suspicion for compressive myelopathy is high, as in malignancy.
| Transverse myelitis | Guillain-Barre syndrome | |
|---|---|---|
| Motor | Early flaccid, late spastic paralysis,If quadriplegia, weakness in LE = UE | Ascending paralysis;Weakness in LE > UE in early disease |
| Sensory | Clearly identifiable sensory level | Mild sensory loss;No spinal cord level |
| Autonomic | Bowel & bladder dysfunction | Cardiovascular instability |
| Cranial nerves | None | Occulomotor/glossopharyngeal facial paralysis |
| EMG/Nerve conduction velocity | Mostly normal | Peripheral motor &/or sensory NCV reduced |
| MRI | Focal enhanced areas of T2 signal | Normal |
| CSF | Pleocytosis;+/- increased IgG index | Absence of pleocytosis;Elevated protein |
Spastic paraparesis describes a upper motor neuron pattern of weakness in the lower limbs
Causes