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Clin Neurophysiol. 2016 Feb;127(2):1657-1663. doi: 10.1016/j.clinph.2015.06.032. Epub 2015 Jul 21.

Ultrasound and electrophysiologic findings in patients with Guillain-Barré syndrome at disease onset and over a period of six months.

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Department of Neurology, Basel University Hospital, Basel, Switzerland; Department of Neurology, University of Tuebingen, Tuebingen, Germany. Electronic address:
Department of Neurology, Basel University Hospital, Basel, Switzerland.
Department of Neurology, Erlangen University Hospital, Erlangen, Germany.
Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.



To investigate cross-sectional areas (CSAs) of several peripheral nerves including the vagus nerve and the diameter of spinal nerves as measured by nerve ultrasound (NUS) and nerve conduction studies (NCS) in Guillain-Barré syndrome (GBS) patients over at least six months compared to healthy controls.


NUS and/or NCS of several nerves, the vagus nerve, and the 5th/6th cervical spinal nerves were performed in patients with GBS at days 2-3 after symptom onset, at days 10-14 after immunoglobulin therapy and after six months compared to healthy controls.


27 GBS-patients and 31 controls were included. Using NUS significant enlargement was found in all measured nerves (P<0.001), except the sural nerve (P=0.086) compared to the controls at onset. The vagus (median 3.0 mm(2) vs. 2.0 mm(2), P<0.0001) and the cervical spinal nerves were significantly enlarged (median 3.5/4.0 mm vs. 2.6/3.2 mm, p<0.0001), the vagus most obviously in patients with autonomic dysregulation (AD, 4.0 mm(2)). Six months later, NCS showed persisting pathology in CMAP-amplitudes with amelioration of F-wave pathology. NUS showed restitution in the spinal nerves (median 2.6/3.2 mm) and the vagus (median 2.0 mm(2)) in all patients excluding the vagus in those with persistent AD (median 4.0 mm(2)). The peripheral nerves did not change significantly (P>0.05).


Ultrasonographic detection of cervical spinal nerve enlargement supports the diagnosis of GBS in the early phase. Its regression may be a good parameter for the clinical restitution over time. Vagus enlargement may be a risk marker for development of AD.


Ultrasound is a reliable diagnostic follow-up tool in early GBS.


Guillain–Barré syndrome; Immune-mediated neuropathy; Nerve ultrasonography; Spinal nerves; Vagus nerve

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