Spinal nerve pathology in Guillain-Barré syndrome associated with COVID-19 infection

Abstract

See article on pages E76 in this issue.

Keywords: COVID-19 infection, endoneurial edema, Guillain-Barré syndrome, MRI, spinal nerve, STIR.

FIGURE 1

Pathological features in L5 spinal root, fifth lumbar nerve, and sciatic nerve in a severe GBS patient who died on day 9. A, Note the nerve enlargement as of the vertebral foramen (VF). B, Semithin cross‐section of L5 ventral root showing no identifiable abnormalities. C, Semithin cross‐section of the ventral ramus of the fifth lumbar nerve, illustrating widespread endoneurial edema that is more conspicuous in areas adjacent to the septum (arrows) and in subperineurial areas (asterisk), resulting in a spacing‐out phenomenon giving the false impression of reduced density of myelinated fibers. D, High‐power view of the L5 ventral root showing preservation of the density of myelinated fibers with occasional mononuclear cells (arrow) and a fiber exhibiting myelin vacuolization (asterisk). E, High‐power view of the subseptum area indicated by the arrow in C. Note the presence of florid inflammatory edema with numerous mononuclear cells (arrows), fibers with inappropriately thin myelin sheaths (asterisk), and fibers exhibiting myelin vacuolation (arrowhead). F, Semithin section of sciatic nerve showing some demyelinated axons (white arrows), fibers with vacuolar degeneration (arrowheads), mononuclear cells (black arrows), and slight endoneurial edema more marked in subperineurial areas (asterisks). Overall, lesions clearly predominate in the ventral ramus of the fifth lumbar nerve [Color figure can be viewed at wileyonlinelibrary.com]