Simultaneous Guillain-Barre Syndrome and Acute Disseminated Encephalomyelitis

Acute disseminated encephalomyelitis (ADEM) and Guillain-Barre syndrome (GBS) are both immunologically mediated two inflammatory demyelinating diseases. The combined demyelinating process in the CNS and PNS is a rare occurrence. This may be explained by a shared epitope between peripheral and central nervous system myelin. We report a 49-year-old male patient who developed numbness and mild weakness in all his extremities two weeks after an upper respiratory infection. The elevated CSF protein levels and delayed F waves fulfilled the criteria of GBS. In a few days irritability and behavioral disturbances appeared. Cranial MRI revealed bilateral periventricular white matter and left hippocampus T2-weighted hyperintense ovoid lesions. Thoracal MRI revealed T1-weighted hypointense and T2-weighted hyperintense fusiform lesions at T3-4 and T10-11 levels with contrast enhancement. A diagnosis of acute disseminated encephalomyelitis (ADEM) was considered. After corticosteroid administration sensorial symptoms and urinary retention were improved. No clinical and radiological findings of a new attack were observed during the three year follow-up. The diagnosis was Guillain-Barre syndrome associated with ADEM. (Archives of Neuropsychiatry 2009; 46: 76-9)