Objectives: Only a few cases of simultaneous acute demyelination of both the peripheral and central nervous system were described. This entity is not well described.
Methods: We performed a retrospective chart review of 3 patients who were diagnosed with Guillain-Barré Syndrome and ADEM during the same hospitalization.
Results: Our three patients had a viral prodrome and had a confirmed diagnosis of Guillain-Barré and ADEM during the same admission. Two of our patients presented with Guillain-Barré, but with atypical findings. One had rapidly progressing weakness, some degree of mental slowness, and needed intubation early in the course. He had decreased but not completely absent reflexes. The second patient had an early lumbar puncture showing normal proteins and atypical nerve conduction studies for Guillain-Barré. The clinical diagnosis was confirmed by MRI of the spine which showed enhancement of the ventral and dorsal roots of the distal cord and cauda equina. In these two cases, the MRI of the head showed typical lesions of ADEM. The third patient presented as a typical ADEM. In the course of the hospitalization, he lost his deep tendon reflexes. Nerve conduction studies and MRI of the spine confirmed the diagnosis of Guillain-Barré. All three patients were treated promptly with intravenous immunoglobulin or corticosteroids and all had a good outcome.
Conclusion: Guillain-Barré syndrome and ADEM can occur simultaneously in the pediatric population. This could be explained by a shared epitope between the PNS and the CNS myelin sheath. Further research is necessary to better describe this entity and its prognosis.
