5例Miller-Fisher综合征临床分析

目的 探讨Miller—Fisher综合征的临床特点。方法回顾性分析5例Miller-Fisher综合征患者发病年龄、发病形式、首发症状、临床表现、影像学特征、脑脊液检查结果及预后情况，并结合文献进行临床分析。结果Miller-Fisher综合征发病年龄为17～73岁；多为亚急性起病；首发症状主要为视物成双和四肢无力；主要神经系统症状为视物成双、眼球运动障碍、声音嘶哑、饮水呛咳及四肢无力、麻木。主要神经系统体征为眼外肌麻痹．水平性眼震，周围性面瘫，共济失调，深、浅感觉减退，腱反射减弱或消失。辅助检查：脑脊液（CSF）蛋白升高5例，CSF细胞轻度升高3例。肌电图示神经源性损害3例。脑CT和MRI检查均未发现异常。予人免疫球蛋白、营养神经、改善微循环、脱水及对症支持治疗可有效缓解病情。治疗10d症状即改善。3个月内5例患者临床症状消失，但仍有腱反射减弱或消失。结论对于感染、接种疫苗后出现复视、眼外肌麻痹、面瘫、饮水呛咳、四肢麻木无力、共济失调、腱反射消失等神经系统局灶体征，应高度怀疑Miller—Fisher综合征，经人免疫球蛋白、营养神经、改善微循环、脱水及对症支持治疗后．大多数患者预后良好。

Clinical analysis of Miller-Fisher syndrome (5 cases report)

Objective To explore the clinical characteristics of Miller-Fisher syndrome （MFS）. Methods Five patients with MFS were analyzed retrospectively on the age and pattern of onset, initial symptom, clinical characteristics, imaging characteristics, result of cerebrospinal fluid and prognosis. The literature was reviewed to study the cause and clinical characteristics of MFS. Results The MFS mainly occurred in 17-73 years with acute or subacute onset. The initial symptoms included double vision and weakness. The major symptoms of nervous system included double vision, ophthalmoplegia,dysarthria,dysphagia and paraesthesia of extremity. The major physical sign included ophthalmoplegia externa, nystagmus, ataxia, hypesthesia, peripheral facial paralysis, and weak or disappeared tendon reflex. Increased total protein （5 patients） and the number of cells （3 patients）were detected in the cerebrospinal fluid. Three cases of auxiliary fibers injury were found in electromyologram （EMG）. There was no positive findings in computer tomography （CT） or magnetic resonance imaging （MRI）. It had good therapeutic effects by using immunoglobulin, nerve,nutritional agents. Improvement of microcirculation,dehydration and support treatment, 5 patients symptoms disappeared in 3 months hut weakness or disappeared tendon relex still existed. Conclusions The patients with ophthalmoplegia externa, nystagmus, ataxia, hypesthesia, peripheral facial paralysis, and weak or disappeared tendon reflex should be suspected of MFS. Miller-Fisher syndrome mainly involves peripheral nervous system. It is essential to treat with immunoglobulin after the diagnosis,and has good prognosis.