Fisher综合征2例报告

例1,男,68岁,以"感冒"后四肢远端麻木4天,吐字不清、行走不稳、复视2天于2001年3月24日入院.既往健康.查体:神清,轻度构音障碍,双瞳孔等大同圆,对光反射正常,双眼球内收、外展、上视、下视均受限,无眼震,四肢肌力、肌张力正常,四肢腱反射减弱,指鼻试验及跟膝胫试验欠稳准,步基宽,走直线不能, 双侧病理征(-).入院10天出现双侧面瘫,入院17天腰穿示脑脊液压力1.77kPa,潘氏反应(+),细胞数为0,蛋白1.0g/L,葡萄糖3.34mmol/L.临床诊断为Fisher综合征.予大剂量丙种球蛋白冲击5天,营养神经治疗,10周后患者痊愈.     

Fisher综合征5例临床分析

Fisher综合征是急性Guillain-Barre综合征(GBS)的一种特殊或变异型,临床较少见,现将临床所见的5例分析如下. 1临床资料 男3例,女2例,年龄25～74岁,平均年龄45.2岁;诱因:上呼吸道感染4例,不明原因1例;首发症状:复视2例,四肢麻木乏力3例;眼肌麻痹5例,其中1例有部分眼内肌麻痹,眼外肌全麻痹4例,部分麻痹1例,核间性眼肌麻痹1例;其他颅神经损害:双侧周围性面瘫1例,舌咽、迷走神经麻痹2例,正常2例;四肢肌力:正常2例,肌力Ⅳ～Ⅴ级3例;肢体感觉:正常3例,四肢末端手套、袜套样痛触觉减退2例;共济失调5例,表现为步态不稳,肌张力降低等;腱反射消失4例,减弱1例.     

Fisher综合征5例分析

Fisher综合征也称Miller-Fisher Syndroms，是急性炎性脱髓鞘性多神经病(AIDP)，即格林-巴利综合征的变异型。本病在基层医院少见，常易误诊。本文对我院收治的5例Fisher综合征病例进行分析，现报道如下。     

伴眼内肌麻痹和频繁呕吐的Fisher综合征一例报告

1临床资料 患者女．16岁，回族。因“头痛，头晕1周，视物成双5d”被收入院。人院前1周无明显诱因自觉双颞部头痛、头晕、全身乏力、恶心、发热。2d后视物模糊、成双。继而呕吐频繁且进食后加重，腹胀，精神差．无肢体麻木无力。发病前有“感冒”史。查体：内科检查无异常。神经系统：双眼球各方向活动均受限，双瞳孔等大等圆，直径4mm．光反射减弱；余颅神经无异常，感觉正常。     

表现为Fisher综合征的脑膜癌病

表现为Ｆｉｓｈｅｒ综合征的脑膜癌病王翠兰刘梅仕邓小梅于素贞脑膜癌病是恶性肿瘤弥漫性或多灶性脑膜转移，是恶性肿瘤致死的重要原因之一。近年来随着脑脊液（ＣＳＦ）细胞学的开展，现已基本实现生前诊断和治疗。以Ｆｉｓｈｅｒ综合征为首发症状的脑膜癌病国内尚未见报...     

Fisher综合征9例临床分析

Fisher综合征是急性炎症脱髓鞘性多神经根疾病(AIDP),又称格林-巴利综合征(GBS)的一种特殊类型或变异型,临床上并非罕见。对本病的认识不足极易造成误诊,有必要对其临床特点进行探讨。现将我院1993-01~2004-10收治的9例病人分析如下。1临床资料1·1一般资料男5例,女4例,年龄21~50岁,平均35·8岁。病前有上呼吸道感染史5例,消化道感染史2例,2例无明显前驱因素。9例病人中,入院诊断为Fisher综合征5例,脑干中风1例,小脑梗死1例,多发性硬化1例,另有1例诊断为周期性瘫痪。1·2临床表现9例病人均为急性起病,均有不同程度的眼肌麻痹,其中双侧眼…     

Fisher综合征

为了提高对Ｆｉｓｈｅｒ综合征的认识，本文报告了１１例Ｆｉｓｈｅｒ综合征，它为格林－巴利综合症变异性，属迟发性过物自身免疫疾病。发病前１－４周有呼吸或消化道病毒感染史，临床表现：（１）双侧眼外展伸经麻痹，对称性共济失调，双侧深反射消失。（２）脑脊液：蛋白－细胞分离。（３）预后良好，肾上腺皮质激素治疗效果好。     

Fisher综合征9例临床分析

Fisher综合征是急性炎症脱髓鞘性多神经根疾病(AIDP)。又称格林-巴利综合征(GBS)的一种特殊类型或变异型，临床上并非罕见。对本病的认识不足极易造成误诊，有必要对其临床特点进行探讨。现将我院1993-01～2004-10收治的9例病人分析如下。     

以直立性低血压为主要临床表现的原发性干燥综合征一例报告

患女，47岁，主因“发作性头晕4d，加重4h”于2001年6月23日入院。患于4d前晨起床时突然出现头晕、双眼发黑，伴恶心，休息4—5min后缓解。无明显诱因出现腰、腹、背部疼痛并伴有腹泻。此后，站立或活动后即感头晕。6月22日晨起头晕、眼前发黑，伴短暂意识丧失约1～2min，随后出现耳呜、恶心等症状，并呕少量胃内容物。无抽搐、大小     

僵肢综合征临床分析

目的 探讨僵肢综合征（SLS）临床及电生理特点。方法 对1例僵肢综合征临床资料进行分析。并综合文献。阐述该病的临床及电生理特点。治疗方案及预后。结果 僵肢综合征是僵入综合征的变异型的一种，多与自身免疫及副肿瘤性两性因素有关，肌电图显示在静息时出现连续运动单位活动（CMUA）。与经典僵人综合征（SMS）不同，多表现为肢体远端强直及痛性痉挛，躯干相对较少累及；患者有多种抗体，糖尿病及血清抗谷氨酸脱羧酶抗体（GAD）较少见，个别患者患乳腺癌或肺小细胞癌；治疗效果不如经典SMS。结论 这是1例罕见的乳腺癌伴僵肢综合征的病例，根据临床特点，肌电图可以确诊，具有副肿瘤性及免疫学异常的特点，切除肿瘤后用大剂量激素及安全类药物治疗有效。     

34例变异型吉兰-巴雷综合征的临床特点分析

目的 分析变异型吉兰-巴雷综合征(GBS)的临床特点。方法 回顾性分析2012年10月-2019年3月变异型GBS患者的临床表现、电生理及脑脊液特点。结果 共34例患者,包括Miller-Fisher综合征(MFS)及MFS变异亚型共12例,脑神经变异型(CNV)12例,急性感觉神经病(ASN)1例,急性泛自主神经病(APN)1例,咽-颈-臂(PCB)2例以及不能明确分型6例。34例变异型GBS患者中男20例、女14例(P=0.392); 发病年龄17～80岁,平均年龄(53.38±14.99)岁,中年(41～65岁)组所占比例最多(P=0.000); 20例有前驱事件,上呼吸道感染占65%; 首发症状以肢体麻木(38.2%)、吞咽困难(29.4%)、吐词不清(23.5%)多见; 97.1%的患者发病4周内达高峰; 需机械通气者5.9%; 疾病开始恢复的中位时间13 d,住院中位时长13.5 d; 64.7%的患者腱反射减弱或消失; 在完成腰椎穿刺检查的患者中脑脊液蛋白-细胞分离者58.6%; 发病到完善神经电生理检查的平均时间(10.70±7.32)d,85.2%神经电生理检查表现异常; 50%患者给予静脉注射免疫球蛋白(IVIg)治疗,14.7%患者给予激素治疗,8.8%患者给予免疫球蛋白联合激素治疗,除外1例患者主动要求出院,其余治疗均有效。结论 变异型GBS临床表现多样,常无典型急性四肢对称性迟缓性麻痹等症状,临床诊断需要综合判断,出现一些少见的临床表现并不能除外GBS的诊断,脑脊液和神经电生理检查可以帮助提高诊断,详尽的病史及神经系统查体尤为重要,免疫球蛋白和激素治疗有效。     

Miller Fisher Syndrome in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Systematic Review

Background and PurposeMiller Fisher syndrome (MFS) is a subtype of Guillain-Barré syndrome characterized by the triad of ophthalmoparesis, areflexia, and ataxia. Although cases of MFS have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, no studies have synthesized the clinical characteristics of patients with this condition.MethodsIn this rapid systematic review, we searched the PubMed database to identify studies on MFS associated with SARS-CoV-2 infection.ResultsThis review identified 11 cases, of whom 3 were hospitalized with motor and/or sensory polyneuropathy as the first sign of SARS-CoV-2 infection. SARS-CoV-2 RNA was not detected in analyses of cerebrospinal fluid, suggesting a mechanism of immune-mediated injury rather than direct viral neurotropism. However, antiganglioside antibodies were found in only two of the nine patients tested. It is possible that target antigens other than gangliosides are involved in MFS associated with SARS-CoV-2 infection.ConclusionsThe present patients exhibited clinical improvement after being treated with intravenous immunoglobulin. Although rare, patients with SARS-CoV-2 infection may present neurological symptoms suggestive of MFS. Early recognition of the MFS clinical triad is essential for the timely initiation of treatment.     

MRI of an infant with Fisher syndrome

A 15-month-old female infant with nystagmus, gait disturbance, diminished reflexes, ophthalmoplegia, and facial paresis was diagnosed as having Fisher syndrome. Magnetic resonance imaging revealed a transient, high-signal-intensity lesion on the left side of the cerebellum on T2-weighted images. The ataxia of Fisher syndrome is not compatible with polyneuritis, but can be explained by a cerebellar lesion, as seen in this case. Received: 29 March 1996     

Miller Fisher syndrome related to Orientia tsutsugamushi infection

Miller Fisher syndrome is typically associated with a preceding infection, especially with Campylobacter jejuni. We describe a patient with Miller Fisher syndrome following Orientia tsutsugamushi infection, which to our knowledge has not been previously reported.     

Miller Fisher综合征14例报道

目的:分析14例Miller Fisher综合征的临床特点和预后。方法:回顾性分析1998年1月至2007年3月我院收治的14例Miller Fisher综合征患者,应用Microsoft Access 2003建立数据库,分析患者的各种症状、体征和各项检查和预后。结果:病前感染者11例,其中肠道感染8例,双侧动眼神经损害14例,眼内肌的损害7例,对光反射消失5例,共济失调9例,头晕7例,腱反射减低12例,肌力减退7例,周围神经损害5例,病理征3例,蛋白-细胞分离12例,影像学异常2例,肌电图改变7例。结论:Miller Fisher综合征临床症状复杂,可在经典的三联征基础上伴有其他体征,也可仅有其中的两联征,预后较好。     

Miller Fisher syndrome in infancy

Miller Fisher syndrome (MFS) is characterized by the triad of ataxia, areflexia and ophthalmoplegia. It is exceptional for infants to be involved. Two infants, aged 11 and 16 months, developed acute-onset MFS. Both patients had prodromal upper respiratory tract infection. Pupillary responses to light, strength and sensation modalities were preserved. One patient was lethargic for a day; the electroencephalogram disclosed slightly slow background activity that later became normal. The other received high-dose intravenous immunoglobulins for 5 consecutive days starting at once on admission; within the next 7 days he became asymptomatic. Increased cerebrospinal fluid protein content and delayed nerve conduction studies with prolonged distal latencies were encountered in both patients.     

首发为Fisher综合征表现的肺癌转移致脑膜癌病一例

目的报告1例首发表现为Fisher综合征的脑膜癌病(MC),探讨其临床表现、影像及脑脊液(CSF)改变的特点。方法对1例首发症状表现Fisher综合征的MC进行病史采集和临床查体,分析其影像和CSF结果。结果患者以典型的Fisher综合征起病,后逐渐出现纳差、呕吐等颅高压表现,头颅MRI表现为脑干脑膜广泛强化,PET-CT提示肺癌并脑膜及骨转移。CSF发现肿瘤细胞。结论首发症状为Fisher综合征的肺癌转移致MC临床罕见,临床症状的多样性是MC容易误诊的主要原因。     

Recurrent Miller Fisher syndrome: clinical and laboratory features

To present two patients with Miller Fisher syndrome (MFS) recurrence after 35 and 44 years and review of the literature on recurring MFS. All identified cases with recurrent MFS were evaluated. Age, gender, clinical features of first and recurrent MFS, course of disease, laboratory findings, therapy and outcome were transformed into tables. Twenty‐eight patients (16 men, 12 women; mean age at the first episode 34 years (range 13–57 years); mean age at the latest episode 47 years (range 21–66 years) with a total of 70 MFS episodes were identified. Twenty‐one patients had a single recurrence, five patients had two recurrences, one patient had four recurrences and one patient had seven recurrences. The mean interval between attacks was 9.45 years (3 months to 44 years). In 76% of the initial episodes and in 81% of the recurrent episodes, an infectious disease preceded MFS. Additional facial and bulbar symptoms and autonomic disturbances were frequent findings. Cerebrospinal fluid (CSF) and electrodiagnostic findings were unspecific. If tested, autoantibodies against GQ1b had been positive in all episodes. In about half of the patients, immunotherapy was applied. The outcome was favourable in most patients. Recurrence of MFS is a rare quite uniform condition with a mostly favourable prognosis.     

Prediction of disease progression in Miller Fisher and overlap syndromes

Patients with Miller Fisher syndrome (MFS) may have a relatively mild clinical course or progress to Guillain‐Barré syndrome (GBS) with limb weakness (MFS‐GBS overlap syndrome). Other variants in this spectrum are GBS with ophthalmoparesis and Bickerstaff's Brainstem encephalitis (BBE). To compare the clinical course of MFS and overlap syndromes and to identify predictors of disease progression. In a prospective study of 170 patients with GBS and variant forms, 37 (22%) had a MFS, MFS‐GBS overlap syndrome, ophthalmoplegic GBS or BBE. The clinical, serological, and electrophysiological features were compared. Twenty‐three patients presented with MFS, of which 10 (43%) developed limb weakness (MFS‐GBS overlap syndrome). All these transitions occurred in the first week after onset of symptoms. There were no differences in the clinical, electrophysiological and serological features at entry between MFS and MFS‐GBS. Twelve patients had ophthalmoplegic GBS and the disease severity at nadir and outcome was worse than in the patients with a MFS‐GBS overlap syndrome. No early predictors for progression from MFS to MFS‐GBS overlap syndrome were found. All transitions occurred in the first week. This finding implicates that all patients with MFS need careful monitoring for at least 1 week.