[Miller-Fisher syndrome: clinical features, associated infections and clinical course in 8 cases].
OBJECTIVE
Miller-Fisher syndrome (MFS) is considered the most common variant of Guillain-Barré syndrome (GBS) and is characterized by the clinical triad of ophthalmoplegia, ataxia and areflexia. Respiratory involvement and relapses are unusual. Patients with MFS usually have a good recovery and no residual deficits. We describe the clinical features, associated infections and evolution in eight patients with MFS.


METHODS
Eight cases of MFS and sixty-one of GBS were studied between 1994 and 2003. All cases showed the clinical triad of MFS without major limb weakness or other signs suggestive of CNS involvement.


RESULTS
The proportion of MFS with respect to GBS during the same period was 13.1%. Four had a positive serology for Epstein-Barr virus, Salmonella enteritidis, Chlamydia pneumoniae and Mycoplasma pneumoniae. Our cases showed facial palsy (75%), dysphagia (75%), pupillary abnormalities (37.5%) and ventilation support (37.5%). Antiganglioside antibodies, determined in three cases (4 episodes), were positive [GQ1b (50%) and GD1b (50%)]. In all cases, there was a markedly reduced amplitude of the distal sensory as well as frequent axonal degeneration signs. The oldest three patients relapsed and required ventilation support.


CONCLUSIONS
We report for the first time an association between S. enteritidis and C. pneumoniae and MFS. Older patients in our series suffered a faster disease progression with need of ventilation support. We conclude that an older age correlates with poor prognosis and relapses.
Rodríguez Uranga
Juan Jesús
JJ
Servicio de Neurología, Hospitales Universitarios Virgen del Rocío, Sevilla, España. juanj2000@vodafone.es
Delgado López
Francisco
F
Franco Macías
Emilio
E
Sánchez Arjona
María Bernal
MB
Martínez Quesada
Carlos
C
Palomino García
Alfredo
A
D000328:Adult; D000368:Aged; D006801:Humans; D007239:Infections / Q000150:complications; D008297:Male; D008875:Middle Aged; D019846:Miller Fisher Syndrome / Q000150:complications* / Q000175:diagnosis*