Lesions of the spinal cord in polyradiculoneuropathy of unknown aetiology and a possible relationship with the Guillain-Barré syndrome.

The following report describes two patients with polyradiculoneuropathy of unknown aetiology and displaying degeneration of the spinal cord secondary to severe and long-standing damage to the spinal nerve roots. With the possible exception of the tabetic form of syphilis, where the relationship of spinal cord lesions to spinal root pathology is still open to question 1963), cord involvement is a rare consequence of radiculoneuropathies of known aetiology and is also rare in the poly-radiculoneuropathies of unknown cause. Cases of root disease which fall into the latter category are often considered to bear the Guillain-Barre syndrome. Concepts concerning the nature or definition of this syndrome have undergone many changes over have recently pointed out that a controversy still exists concerning what is and what is not the syndrome. They reiterate the clinical aphor-ism that '.. . the Guillain-Barre syndrome is easy to diagnose but impossible to define. . .'. Because patients with the syndrome may in reality fall into several different and as yet unknown aetiological groups, some workers may prefer to abandon the eponymous designation, even when the clinical picture is clear-cut, and to refer instead only to polyradiculoneuropathies of unknown aetiology. Classically, the Guillain-Barre syndrome is recognized by the presence of bilateral motor weakness which usually ascends in fatal cases. In addition, sensory deficits of the glove and stocking variety and of the segmental or radicular type are common, the latter being particularly frequent in ultimately fatal cases (Wiederholt et al., 1964; Haymaker and Kernohan, 1949). The investigators mentioned above also established that albumino-cytological dissociation of the cerebrospinal fluid is not a 'Requests for reprints should be sent to constant finding although it is often present and may be considered a classical manifestation of the syndrome. The pathological changes in cases considered to have the Guillain-Barre syndrome are characteristic even in the presence of wide variations in clinical symptoms (Haymaker and Kernohan, 1949). These changes consist of degeneration of the peripheral nerves with a concentration of the disease process on the spinal nerve roots. Alteration of myelin exceeds axonal damage and a negligible inflammatory cell infiltrate is present. Both cases presented here had bilateral motor weakness and albumino-cytological dissociation of the spinal fluid, but the significance of these findings was overshadowed or obscured by other symptoms which reflected apparently unrelated disease processes as well as the intensity and duration of the changes in the nerve roots. The root pathology …