MALIGNANT ASTROCYTOMA OF THE CERVICO-MEDULLARY JUNCTION MASQUERADING AS GUILLAIN-BARRE-SYNDROME

Brainstem gliomas are rare primary brain tumours which most commonly o ccur in the midbrain and pens. Malignant gliomas and tumours at the ce rvico-medullary junction are particularly unusual. The diagnosis of tu mours at this site is particularly difficult using computed tomographi c (CT) scanning owing to artifacts around the base of the skull. Intri nsic tumours of the cervico-medullary junction may lead to a dissociat ed motor deficit and the onset of symptoms can be rapid. We describe a patient in whom an isolated ascending motor deficit in association wi th a raised cerebrospinal fluid protein and a normal CT scan led to an erroneous diagnosis of Guillain - Barre syndrome. The patient was tre ated on the intensive care unit for an I-week period before further in vestigation demonstrated a malignant glioma of the cervico-medullary j unction. We recommend confirmation of the diagnosis of polyradiculopat hy by nerve conduction studies wherever possible.