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Variants of Guillain-Barré Syndrome: Miller Fisher Syndrome, Facial Diplegia and Multiple Cranial Nerve Palsies

Published online by Cambridge University Press:  18 September 2015

Ashfaq Shuaib  and
Werner J. Becker
Ashfaq Shuaib*
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary
Werner J. Becker
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary
*
Calgary General Hospital, 841 Centre Avenue East, Calgary, Alberta, Canada T2E 0A1
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Abstract:

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We report the experience at a large teaching hospital over a 10 year period with Miller Fisher Syndrome, facial diplegia, and multiple cranial nerve palsies. In these patients, absence of drowsiness on examination, normal cranial CT scans, albumino-cytological dissociation on CSF examination and slowing of nerve conduction, all suggest that a peripheral nerve dysfunction is the underlying mechanism. Pertinent literature is reviewed, in an attempt to separate these probable variants of Guillain-Barré Syndrome from brainstem encephalitis, with which they may be confused.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 14 , Issue 4 , November 1987 , pp. 611 - 616
Copyright
Copyright © Canadian Neurological Sciences Federation 1987

References

1.van, Bogeart L, Philips, F, Radermecker, J, et al. Essai sur un groupe epidemique de cas de polyrediculonevrite avec dissociation albuniocytologique du liquide cephilo-rachidien (type Guillain Barre) chez l’enfant et l’adulte, J Belg Neurol Pschiat 1938; 38: 151–211.Google Scholar
2.Fisher, CM.An unusual variant of acute idiopathic polyneuritis (Syndrome of ophthalmoplegia, ataxia, and areflexia). New England Journal of Medicine 1956; 255: 57–65.CrossRefGoogle ScholarPubMed
3.Adams, R, Victor, M.Principles of Neurology. McGraw Hill Book. Company 1985. Page: 969.Google Scholar
4.Pleasure, DE, Schotland, DL, in Merriet’s Textbook of Neurology. Edited by Lewis, P.Rowland, Lea. & Febiger, 1984. Page: 486.Google Scholar
5.Ropper, AH, Shahani, BT.in Peripheral Nerve Disorders. Asbury, AK, Gilliat, RW, eds. Neurology 4, Butterworths International Medical Reviews 1985. Page: 27.Google Scholar
6.Trautmann, JC, Barnett, RC, in Peripheral Neuropathy. Dyck, PJ, Thomas, PK, Lambert, EH, Bunge, R, eds. WB Saunders Company 1984. Page: 1220.Google Scholar
7.Asbury, AK. Diagnostic considerations in Guillain Barre Syndrome. Ann Neurol 1981; 9: 1–5 (Suppl 1).CrossRefGoogle ScholarPubMed
8.Guillain, G.Les polyradiculonevrites avec dissociation albumino- cytologique et a evolution favorable, (syndrome de Guillain et Barre) J Belge. Neurol Psychiat 1938; 38: 323–329.Google Scholar
9.Munsat, T, Barnes, J.Relations of multiple cranial nerve dysfunc- tion to the Guillain Barre syndrome. J Neurol Neurosurg Psychiat 1965, 28: 115–120.CrossRefGoogle Scholar
10.Charous, DI, Saxe, BI.The Landry Guillain Barre syndrome. Report of an Unusual case, with a comment on Bell’s Palsy. The New England J of Medicine 1962; 267: 1334–1338.CrossRefGoogle ScholarPubMed
11.Elizan, TS, Spire, JP, Andiman, RM, Baughman, FA, Lloyd Smith, DL.Syndrome of acute idiopathic ophthalmoplegia with ataxia and areflexia. Neurol 1971; 21: 281–292.CrossRefGoogle ScholarPubMed
12.Sauron, B, Bauche, P, Cathala, H, Chain, F, Castaigne, P.Miller Fisher syndrome: Clinical and physiologic evidence of peripheral origin in ten cases. Neurology 1984; 34: 953–956.CrossRefGoogle Scholar
13.Weiss, JA, White, JC.Correlation of IA afferent conduction with ataxia of Fisher’s syndrome. Muscle and Nerve 1986; 9:327–332.CrossRefGoogle Scholar
14.Al-Din, ASN, Anderson, M, Bickerstaff, ER, Harvey, I.Brainstem encephalitis and the syndrome of Miller Fisher. A clinical study. Brain 1982; 105: 481–495.Google ScholarPubMed
15.Barontini, F, Sita, D.The nosological position of Fisher’s syndrome (ophthalmoplegia ataxia and areflexia). J of Neurol 1983; 229: 33–44.CrossRefGoogle ScholarPubMed
16.Meienberg, O, Ryffel, E.Supranuclear eye movement disorders in Fisher’s syndrome of ophthalmoplegia, ataxia, and areflexia. Report of a case and literature review. Arch of Neurol 1983; 40: 402–405.CrossRefGoogle ScholarPubMed
17.Guiloff, RL.Peripheral nerve conduction in Miller Fisher Syndrome. J Neurol Neurosurg and Psych 1977; 40: 801–807.CrossRefGoogle ScholarPubMed
18.Schapira, AHV, Thomas, PK.A case of recurrent idiopathic ophthalmoplegic neuropathy (Miller Fisher Syndrome). J Neurol Neurosurg PsyQ 1986; 49: 463–464.CrossRefGoogle ScholarPubMed
19.Keane, JR.Tonic pupil with acute ophthalmoplegic polyneuritis. Ann Neurol 1977; 2: 393–396.CrossRefGoogle Scholar
20.Allen, MW, MacQueen, JC.Opthalmoplegia ataxia and the syn- drome of Landy Guillain Barre. Tran Am N Assoc 1964; 89: 98–103.Google Scholar
21.Jampel, R, Haidt, SJ.Bell’s phenomenon and acute idiopathic polyneuritis. Am J Ophthalmol 1972; 74: 145–153.CrossRefGoogle ScholarPubMed
22.Ricker, K, Hertel, G.Electrophysiological findings in the syndrome f acute ocular muscle palsy and ataxia. (Fisher Syndrome). J of Neurol 1976,214: 33–34.CrossRefGoogle Scholar
23.Becker, WJ, Watters, GU, Humphreys, P.Fisher syndrome in childhood. Neurol 1981; 31: 555–560.CrossRefGoogle ScholarPubMed
24.Swick, HM.Pseudointernuclear ophthalmoplegia in acute idiopathic polyneuritis. (Fisher syndrome). Am J Ophthalmol 1977; 83: 355–357.Google Scholar
25.Weintraub, MI.External ophthalmoplegia complicating acute infec- tious polyneuritis. Am J Ophthalmol 1974; 77: 725–728.Google Scholar
26.Ropper, AL.The CNS in Guillain Barre syndrome Arch of Neurol 1983; 397–398.Google Scholar
27.Meienberg, O.Lesion site in Fisher’s syndrome. Arch of Neurol 1984; 41: 250–251.CrossRefGoogle ScholarPubMed
28.Gibberd, FB.Ophthalmoplegia in acute polyneuritis. Arch Neurol 1970; 23: 161–164.CrossRefGoogle ScholarPubMed
29.Blau, I, Casson, I, Lieberman, A, Weiss, E.The not so benign Miller Fisher syndrome. Arch Neurol 1980; 37: 384–385.CrossRefGoogle ScholarPubMed
30.Dehaene, I, Martin, JJ, Geens, K, Cros, P.Guillain-Barre Syndrome and ophthalmoplegia: Clinicopathological study of central and peripheral nervous system including the oculomotor nerve. Neurol 1986; 36: 851–854.CrossRefGoogle Scholar
31.Phillips, MS, Stewart, S, Anderson, JR.Neuropathological findings in Miller Fisher syndrome. J Neurol Neurosurg Psych 1984; 47: 492–495.CrossRefGoogle ScholarPubMed
32.Ropper, AH, Shahani, BG.Proposed mechanism of ataxia in Miller Fisher syndrome. Arch Neurol 1983; 40: 537–538.CrossRefGoogle Scholar
33.Asbury, RB, Arnaso, BG, Adams, RD.The inflammatory lesion in idiopathic polyneuritis. Medicine 1969; 18: 173–215.CrossRefGoogle Scholar
34.Richter, RB.The ataxic form of polyradiculitis. (Landry Guillain- Barré Syndrome). J Neuropath & Expt Neurol 1965 ; 21: 171–185.CrossRefGoogle Scholar
35.Jamal, GA, MacLeod, NW.Electrophysiological studies in Miller Fisher Syndrome. Neurol 1984; 34: 685–688.CrossRefGoogle ScholarPubMed
36.Foss, RD, Daube, JR.Electrophysiology of Miller Fisher Syndrome. Neurol 1986; 36: 234 (Suppl 1).Google Scholar
37.Al-Din, ASN, Khan, RA, Saadah, M, Shiakh, H.Peripheral nerves in Miller Fisher Syndrome. Acta Neurol Scand 1985; 72: 348–350.CrossRefGoogle Scholar
38.McLeod, JG.Electrophysiological studies in Guillain-Barre Syndrome. Ann Neurol 1981;9: 20–27 (Suppl 1).CrossRefGoogle ScholarPubMed
39.Bickerstaff, ER.Brainstem encephalitis, further observations of a grave condition with a benign prognosis. British Medical Journal 1957; 1: 1384–1387.CrossRefGoogle Scholar
40.Bignami, A, Servi, M. Acute internal and external ophthalmoplegia with muscle weakness. Lancet 1973; 1: 1110.Google Scholar
41.Masmouti, K, Rosa, A, Legars, D, Rosat, P, Mison, JP, Galibert, P.Ophthalmoplégie, ataxie et areflexie au cours de metastases frontale et pontine simulant un syndrome de Fisher. Rev Neurol (Paris) 1986; 142: 785–787.Google Scholar
42.Bickerstaff, ER. “Brainstem encephalitis: in Viken, PJ, Bruyn, GW, eds. Handbook of Clinical Neurology. Amsterdam North Holland Publishing Company Limited 1978. 34: 605–609.Google Scholar
43.Juncos, JL, Beai, MF.Idiopathic cranial neuropathy. A fifteen year experience. Brain 1987; 110: 197–211.CrossRefGoogle ScholarPubMed