Reversible conduction failure on the deep tendon reflex response recording in early Guillain-Barré syndrome

Abstract

Objective: To describe the case of a patient with Guillain-Barré syndrome (GBS) showing early reversible conduction failure (RCF) detected by means of serial deep tendon reflex response (T-reflex) study. Methods: A 36-year-old woman had a 5-day history of foot and hand paresthesias ascending to thighs and arms, throbbing interscapular and neck pain, mild to moderate tetraparesis, and areflexia. Nerve conduction studies (NCS) were performed on days 7 and 33 after onset. Results: NCS showed an equivocal electrophysiologic pattern, just an isolated distal RCF being detected on the right radial nerve at initial examination. Motor latency on deltoid muscle after Erb’s point stimulation was preserved. Sensory conduction velocities were normal or slightly slowed. Somatosensory evoked potentials from median and tibial nerves were normal. Initially, F-wave study demonstrated reversible abnormalities, consisting of multiple A waves and low F-wave persistence, minimal F-wave latencies being preserved. Biceps brachii T-reflex was normal, whereas Achilles T-reflex was absent bilaterally, appearing on the second study with normal T-wave morphology and latency, thus conforming to the requirements for RCF diagnosis. Soleus H-reflex was also initially absent. Conclusions: Serial T-reflex study is a useful technique for detecting early RCF of proximal nerve trunks in early GBS. Significance: T-reflex is useful tool for GBS in association with NCS. Keywords: Acute inflammatory demyelinating polyneuropathy, Acute motor axonal neuropathy, A waves, Erb’s point, F waves, Guillain-Barré syndrome, H reflex, Nerve conduction study, Reversible conduction failure, Somatosensory evoked potentials, T reflex