Disclosures: Parth N. Patel, DO: No financial relationships or conflicts of interest

Case Diagnosis: We present a rare case of thoracic myelopathy secondary to a sequestered dorsal epidural herniated disc fragment that initially presented with the classic findings of Guillain-Barré Syndrome (GBS).

Case Description or Program Description: A 58-year-old female presented with progressing bilateral lower extremity weakness and absent lower extremity deep tendon reflexes. Lumbar puncture revealed albuminocytological dissociation. The patient was diagnosed with GBS and treated with intravenous steroids and intravenous immunoglobulin. She later developed ulnar distribution paresthesias, lower extremity spasticity, urinary retention and constipation, prompting further evaluation. Thoracic MRI showed a dorsal epidural lesion causing severe cord compression. The patient underwent a T9-T10 laminectomy with excision of the offending lesion and pathology revealed a sequestered fragment of herniated intervertebral disc. She was eventually discharged home and able to ambulate independently with a walker.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: The patient underwent a successful T9-T10 laminectomy with excision of the lesion causing spinal cord compression and was readmitted to acute inpatient rehabilitation. She was later discharged home from a subacute facility and able to ambulate independently with a walker.

Discussion (relevance): GBS presents with symptoms that can mimic other neurological disorders and make diagnosis challenging. In our case, the diagnosis of GBS was driven by the supportive finding of albuminocytological dissociation. Failure to obtain initial thoracic imaging led to a significant delay in accurate diagnosis, which may have adversely affected our patient’s ultimate functional outcome. To the best of our knowledge, migration of a thoracic disc fragment into the posterior epidural space has only been reported 9 other times in the English-Language literature.

Conclusions: Dependency only on positive albuminocytological dissociation in cases of potential GBS can lead to errors in diagnostic accuracy and delay appropriate treatment. Clinicians should remain mindful that GBS is a diagnosis of exclusion and MRIs of the entire spine should be considered when the diagnosis of GBS is uncertain.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-dorsal-epidural-herniated-disc-fragment-initially-presenting-as-guillain-barre-syndrome/