Recurrent Guillain-Barré syndrome and CNS demyelination

It is commonly assumed that multiple sclerosis exclusively affects the central nervous system but there is growing evidence that it is not so. There is evidence that dysfunction and tissue damage in Guillain-Barre syndrome, chronic idiopathic demyelinating polyneuropathy, and multiple sclerosis result from immune reactions within the peripheral or central nervous systems.1Although it is commonly assumed that multiple sclerosis exclusively affects the central nervous system, central nervous system demyelination has been suggested in chronic idiopathic demyelinating polyneuropathy.2 There are few reports of acute inflammatory demyelinating neuropathy associated with multiple sclerosis.3 4 Here, we report a patient with a recurrent Guillain-Barre syndrome who developed a first episode of central nervous system demyelination several years later. A 26 year old woman was admitted to our hospital because of an acute right hemiparesis. In 1977, at the age of seven, the patient gradually developed a tetraparesis with arreflexia. The neurological deficit reached a peak two weeks after the onset of symptoms. Her CSF showed 217 mg/dl protein without cells. The motor and sensory nerve conduction study included median, ulnar, peroneal, and sural nerves. The motor nerve conduction velocities (NCVs) …