Sural sparing in Guillain-Barré syndrome subtypes: a reappraisal with historical and recent definitions

Clin Neurophysiol. 2016 Feb;127(2):1683-1688. doi: 10.1016/j.clinph.2015.09.131. Epub 2015 Sep 30.


Objective: To ascertain the impact of definition and diagnostic criteria on sural sparing in Guillain-Barré syndrome (GBS).

Methods: We retrospectively reviewed records of 78 consecutive patients with GBS from Birmingham, UK (2001-2012) studied within 21 days post-onset. Different criteria were initially used for subtype classification. Sural sparing was subsequently ascertained using historical/recent definitions.

Results: With Hadden et al.'s criteria, "absent median present sural" and "absent median normal sural" patterns offered sensitivities of 21.7% and 15.2% respectively for AIDP, with specificities of 100% versus axonal GBS. Present sural with two abnormal upper limb responses had a sensitivity of 19.1% and 100% specificity. "Abnormal radial present sural" and "abnormal radial normal sural" patterns had sensitivities of 18.9% and 16.2% and specificity of 100%. With newly-proposed criteria (Rajabally et al., 2015), "absent median present sural" and "absent median normal sural" patterns offered sensitivities of 27.8% and 19.4% respectively, with specificity of 100%. Ulnar patterns were unhelpful with both criteria. Other patterns had suboptimal specificity.

Conclusion: Although of low sensitivity, sural sparing defined by absent median/present sural patterns, is specific of AIDP versus axonal GBS, irrespective of criteria.

Significance: Sural sparing is definition and criteria-dependent in GBS but is specific of AIDP with historical definitions, regardless of criteria.

Keywords: Acute inflammatory demyelinating polyradiculoneuropathy; Axonal; Electrophysiology; Guillain–Barré syndrome; Median; Radial; Sparing; Sural; Ulnar.

MeSH terms

  • Adult
  • Aged
  • Electrodiagnosis / methods
  • Female
  • Guillain-Barre Syndrome / diagnosis*
  • Guillain-Barre Syndrome / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Neural Conduction / physiology*
  • Retrospective Studies
  • Sural Nerve / physiology*