Introduction: Guillain-Barre Syndrome (GBS) is an acute-onset autoimmune-mediated neuropathy. Guillain-Barre Syndrome can be divided into three subtypes: acute inflammatory demyelinating poly-radiculo-neuropathy (AIDP...Introduction: Guillain-Barre Syndrome (GBS) is an acute-onset autoimmune-mediated neuropathy. Guillain-Barre Syndrome can be divided into three subtypes: acute inflammatory demyelinating poly-radiculo-neuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor sensory axonal neuropathy (AMSAN). About 20% of patients with GBS develop respiratory failure and require mechanical ventilation. We are presenting a variant of GBS (Miller Fisher Syndrome, or MFS), which has been confirmed by nerve conduction studies along with the triad of ophthalmoplegia, ataxia, and areflexia. The objective of this study is to present a rare case of chemotherapy-induced GBS. Important clinic findings: A 25-year-old gentleman with acute lymphocytic leukemia on active chemotherapy treatment presented with lower limb weakness. This weakness started after his fifth chemotherapy session. After the sixth chemotherapy, he developed complete paralysis of the left lower limb. Later, he developed right lower limb paralysis. He was also complaining of eye dryness and incomplete closure of both eyes. While inpatient, he developed upper-limb weakness. His chemotherapy consisted of MESNA, cyclophosphamide, doxorubicin, vincristine, cyorabine, and methotrexate. He had ptosis and ophthalmoplegia in the left abducent and right oculomotor regions. He had bilateral facial nerve palsy. He was hypotonic with power grade 3 in the upper limbs and grade 0 in the lower limbs with areflexia. His sensation was intact in the upper limbs but lost in the lower limbs. His planter reflexes were mute. Diagnoses and Management: Intravenous immunoglobulins were given for 5 days. A nerve conduction study showed severe demyelinating sensorimotor polyradoculoneuropathy with secondary axonal loss. The triad of ataxia, ophthalmoplegia, and areflexia was consistent with MFS. The patient improved over the course of the hospital stay but did not reach full recovery. Conclusion: Although GBS is uncommon, it must be taken into account when making a differential diagnosis for any patient presenting with progressive weakness. Drug history is important in all GBS cases.展开更多
目的观察Miller Fisher综合征的临床特点。方法选择我院自2011年7月~2014年7月收治的8例患者的临床资料,观察患者的临床表现、神经体征表现、了解患者病情,并给予辅助检查,同时给予对症治疗。结果患者临床表现多出现四肢乏力、视物模糊...目的观察Miller Fisher综合征的临床特点。方法选择我院自2011年7月~2014年7月收治的8例患者的临床资料,观察患者的临床表现、神经体征表现、了解患者病情,并给予辅助检查,同时给予对症治疗。结果患者临床表现多出现四肢乏力、视物模糊或成双等症状,且出现神经体征表现。给予辅助检查可见,多数患者会出现蛋白-细胞分离、出现免疫球蛋白升高、周围神经及神经根损害等损害,但患者头部CT或MRI检查并无明显异常。结论 Miller Fisher综合征作为一种自限性疾病,早期给予诊断,观察其临床特点,并给予治疗干预,可有效改善患者疗效。展开更多
The Miller Fisher variant is an uncommon but well known syndrome being described as a triad of areflexia, ataxia and complex ophthalmoplegia. It is characterized by antibodies against myelin that affects peripheral ne...The Miller Fisher variant is an uncommon but well known syndrome being described as a triad of areflexia, ataxia and complex ophthalmoplegia. It is characterized by antibodies against myelin that affects peripheral nerves, extraocular muscles and Schwann cells. Anti-ganglioside antibodies have been recognized in disease pathogenesis and decreasing antibody production is the mainstay of treatment. The course is usually benign with improvement after immunomodulation. This case report describes the approach to a patient suspected of having a demyelinating disorder. It delineates the subsets of immune mediated neuropathies in evaluating the diagnosis and emphasizes the need for early therapeutic intervention in achieving a good clinical outcome.展开更多
Purpose: To report an unusual case of Miller Fisher Syndrome (MFS) in which the patient presented with concurrent right eye uveitis. Case Report: We report a case of a 51-year-old gentleman who presented with typical ...Purpose: To report an unusual case of Miller Fisher Syndrome (MFS) in which the patient presented with concurrent right eye uveitis. Case Report: We report a case of a 51-year-old gentleman who presented with typical clinical features of Miller Fisher syndrome including ophthalmoplegia, ataxia, areflexia, ptosis and diplopia following an upper respiratory tract infection. Concurrently, he also had right eye uveitis with raised intraocular pressure. The patient was treated with intravenous immunoglobulin (IVIG), topical steroids and anti-glaucoma eye drops in which he demonstrated good recovery. For diagnostic confirmation, serum antiganglioside antibodies (anti-GQ1b IgG) were later reported to be positive. Conclusion: We described the possible association between MFS and uveitis due to its interrelated pathogenesis. This possible association can lead to early detection and treatment of uveitis.展开更多
文摘Introduction: Guillain-Barre Syndrome (GBS) is an acute-onset autoimmune-mediated neuropathy. Guillain-Barre Syndrome can be divided into three subtypes: acute inflammatory demyelinating poly-radiculo-neuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor sensory axonal neuropathy (AMSAN). About 20% of patients with GBS develop respiratory failure and require mechanical ventilation. We are presenting a variant of GBS (Miller Fisher Syndrome, or MFS), which has been confirmed by nerve conduction studies along with the triad of ophthalmoplegia, ataxia, and areflexia. The objective of this study is to present a rare case of chemotherapy-induced GBS. Important clinic findings: A 25-year-old gentleman with acute lymphocytic leukemia on active chemotherapy treatment presented with lower limb weakness. This weakness started after his fifth chemotherapy session. After the sixth chemotherapy, he developed complete paralysis of the left lower limb. Later, he developed right lower limb paralysis. He was also complaining of eye dryness and incomplete closure of both eyes. While inpatient, he developed upper-limb weakness. His chemotherapy consisted of MESNA, cyclophosphamide, doxorubicin, vincristine, cyorabine, and methotrexate. He had ptosis and ophthalmoplegia in the left abducent and right oculomotor regions. He had bilateral facial nerve palsy. He was hypotonic with power grade 3 in the upper limbs and grade 0 in the lower limbs with areflexia. His sensation was intact in the upper limbs but lost in the lower limbs. His planter reflexes were mute. Diagnoses and Management: Intravenous immunoglobulins were given for 5 days. A nerve conduction study showed severe demyelinating sensorimotor polyradoculoneuropathy with secondary axonal loss. The triad of ataxia, ophthalmoplegia, and areflexia was consistent with MFS. The patient improved over the course of the hospital stay but did not reach full recovery. Conclusion: Although GBS is uncommon, it must be taken into account when making a differential diagnosis for any patient presenting with progressive weakness. Drug history is important in all GBS cases.
文摘目的观察Miller Fisher综合征的临床特点。方法选择我院自2011年7月~2014年7月收治的8例患者的临床资料,观察患者的临床表现、神经体征表现、了解患者病情,并给予辅助检查,同时给予对症治疗。结果患者临床表现多出现四肢乏力、视物模糊或成双等症状,且出现神经体征表现。给予辅助检查可见,多数患者会出现蛋白-细胞分离、出现免疫球蛋白升高、周围神经及神经根损害等损害,但患者头部CT或MRI检查并无明显异常。结论 Miller Fisher综合征作为一种自限性疾病,早期给予诊断,观察其临床特点,并给予治疗干预,可有效改善患者疗效。
文摘The Miller Fisher variant is an uncommon but well known syndrome being described as a triad of areflexia, ataxia and complex ophthalmoplegia. It is characterized by antibodies against myelin that affects peripheral nerves, extraocular muscles and Schwann cells. Anti-ganglioside antibodies have been recognized in disease pathogenesis and decreasing antibody production is the mainstay of treatment. The course is usually benign with improvement after immunomodulation. This case report describes the approach to a patient suspected of having a demyelinating disorder. It delineates the subsets of immune mediated neuropathies in evaluating the diagnosis and emphasizes the need for early therapeutic intervention in achieving a good clinical outcome.
文摘Purpose: To report an unusual case of Miller Fisher Syndrome (MFS) in which the patient presented with concurrent right eye uveitis. Case Report: We report a case of a 51-year-old gentleman who presented with typical clinical features of Miller Fisher syndrome including ophthalmoplegia, ataxia, areflexia, ptosis and diplopia following an upper respiratory tract infection. Concurrently, he also had right eye uveitis with raised intraocular pressure. The patient was treated with intravenous immunoglobulin (IVIG), topical steroids and anti-glaucoma eye drops in which he demonstrated good recovery. For diagnostic confirmation, serum antiganglioside antibodies (anti-GQ1b IgG) were later reported to be positive. Conclusion: We described the possible association between MFS and uveitis due to its interrelated pathogenesis. This possible association can lead to early detection and treatment of uveitis.
