The Localization of the Lesion in Patients With Acute Ophthalmoplegia, Ataxia and Areflexia (Miller Fisher Syndrome)

Abstract

Results of comprehensive serial neurophysiological tests from onset to full recovery in 3 patients with the Miller Fisher syndrome (acute ophthalmoplegia, ataxia and areflexia) are presented. These included EMG and nerve conduction, late response (H and F wave) and direct facial motor and blink reflex studies, computerized motor unit number estimation, automated quantitative sensory threshold measurements, quantitative pupillometric and pupillopharmacological studies and multimodality evoked potential (VEP, SEP and BAEP) and EEG recordings. The results provided unequivocal evidence of peripheral nerve dysfunction. Improvement of the peripheral neurophysiological parameters accompanied or followed clinical recovery in all 3 patients. No abnormality in the CNS pathways investigated by these tests was found. The findings support the conclusion that this syndrome is to be included within the spectrum of acute inflammatory polyneuropathy. The value of serial measurements in detecting milder peripheral nerve lesions is emphasized.

Miller Fisher Syndrome: A Hospital-Based Retrospective Study

“…However, one of them showed improvement in F responses, although both were within normal limits. The result was similar to that reported by Jamal and Ballantyne [31]. Additionally, sensory conduction studies in the 2 patients who had sensory symptoms and signs were both normal.…”

“…In our study, the results of those patients who had brain CT or MRI examinations with or without contrast enhancement were all within normal limits. As in our patients, most of the cases reported [9, 19, 20, 31, 43]did not have respiratory failure, and survived without significant morbidity, although Blau et al [44]reported 2 patients who developed respiratory failure during the illness.…”

“…The results have been controversial. Although some studies revealed no evidence of affection of the peripheral nerves [9, 11, 12, 13], most studies revealed peripheral nerve involvement such as abnormalities in distal motor latencies, motor conduction velocities, sensory conduction velocities, F wave latencies and H reflexes [19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34]. Three out of our 10 patients had abnormal electrophysiological findings.…”

Síndrome de Miller Fisher e neurite óptica: relato de caso

“…A abolição dos reflexos osteotendinosos sugere o acometimento nervoso periférico, achado quase constante dessa entidade. Os principais achados descritos na ENMG são o aumento das latências distais e anormalidade dos potenciais de ação dos nervos sensitivos 5 . Em alguns dos casos descritos, nenhuma anormalidade foi encontrada, o que poderia ser explicado pelo fato de estudos de condução nervosa sensitiva e motora avaliarem os segmentos distais dos nervos periféricos, sendo portanto pouco sensíveis às alterações dos seus segmentos mais proximais 5 .…”

Detection of Serum Anticerebellar Antibodies in Patients with Miller Fisher Syndrome

“…The pathological findings in GBS are infiltrates of inflammatory cells in the spinal roots and peripheral nerves associated with segmental demyelination and variable axonal destruction [8]. While the anatomopathology of the lesions in MFS remains obscure [9], some authors have considered that these pathological lesions are localized in the peripheral nerves or nerve roots [2, 10]. Others have implicated an acute intra-axial and extraaxial inflammation in the midbrain [11, 12]or a combination of central brainstem and peripheral lesions [13].…”