SHM Converge Scientific Abstract ePoster Gallery-Raising the Barré: Refining Post-Operative Differentials

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This case describes a 57-year-old woman with diabetes, hypertension, and lumbar spondylolisthesis who developed new left leg weakness three weeks after spinal surgery. Although she had initially recovered well, she returned with worsening dependence on a walker and marked weakness in hip flexion and foot dorsiflexion. Her sensation was intact, she had diminished Achilles reflexes, and there were no signs of upper motor neuron disease, muscle atrophy, or infection at the surgical site.<br /><br />Initial evaluation for common post-operative complications was unrevealing. Laboratory studies were largely normal except for markedly elevated CSF protein with a normal CSF white count, suggesting an albuminocytologic dissociation. MRI of the brain, cervical, thoracic, and lumbar spine showed no structural cause of her symptoms. EMG demonstrated an acute, widespread, asymmetric neurogenic process with demyelinating features.<br /><br />She was ultimately diagnosed with post-surgical Guillain-Barré syndrome, a rare but important trigger-related presentation of GBS. She was treated with a five-day course of IVIG and made a full recovery.<br /><br />The key teaching point is that new weakness after surgery should not automatically be attributed to local surgical complications. While iatrogenic nerve root injury, nerve root edema, hardware failure, spinal hematoma, cauda equina syndrome, and surgical site infection remain important considerations, demyelinating polyneuropathies such as GBS must also be included in the differential. Early recognition is critical because prompt treatment can lead to rapid recovery and prevent unnecessary testing or interventions.

Asset Subtitle

Rachel A. Akers

Meta Tag

Author List Michelle Sweet, Rachel A. Akers, Sara Chitlik

Category Clinical Vignettes

Concept Postoperative Weakness

Concept Guillain-Barré Syndrome

Concept Weakness

Concept Diagnostic Approach

Concept Areflexia

Distinguished Non-Finalist

Presenter Organization Rush University Medical Center

Presenting Author Rachel A. Akers

Track Adult

Keywords

Guillain-Barre syndrome

post-surgical weakness

demyelinating polyneuropathy

albuminocytologic dissociation

intravenous immunoglobulin

electromyography

spinal surgery complications

left leg weakness

diminished Achilles reflexes

acute neurogenic process

Postoperative Weakness

Guillain-Barré Syndrome

Weakness

Diagnostic Approach

Areflexia