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Controversy About Fisher's Syndrome-Reply.

Controversy About Fisher's Syndrome-Reply. Abstract In Reply. —I do not wish to take an extreme position (even on a point so small), but I disagree on most counts. Separating an ophthalmoplegic-ataxic form of Guillain-Barré syndrome (GBS) from cases with obvious brain-stem signs emphasizes the unusual clinical features produced by peripheral pathology. I have seen scattered perivascular lymphocytes in the brain stem and spinal cord of mundane GBS cases; no doubt this occurs, but no central signs resulted in these cases. Perhaps a fleeting sensory level, Babinski's sign, or unusual neuroophthalmologic finding is explained by these lesions, but this is not brainstem encephalitis. There are also rare patients with inflammatory processes, usually chronic, involving both the brain and peripheral nerves (a patient of mine is described in this issue of the Archives1). The illness described by Bickerstaff2 and Al-Din et al3 is usually distinguishable by clinical signs from the similar Fisher's syndrome produced by GBS. References 1. De la Monte SM, Ropper AH, Dickersin GR, et al: Relapsing central and peripheral demyelinating diseases: Unusual pathologic features . Arch Neurol 1986;43:626-629.Crossref 2. Bickerstaff ER: Brainstem encephalitis: Further observations on a grave syndrome with benign prognosis . Br Med J 1957;1:1384-1387.Crossref 3. Al-Din AN, Anderson M, Bickerstaff ER, et al: Brainstem encephalitis and the syndrome of Miller Fisher: A clinical study . Brain 1982;105:481-495.Crossref 4. Bignami A, Servi M: Acute internal and external opthalmoplegia with muscle weakness . Lancet 1963;1:1110.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Controversy About Fisher's Syndrome-Reply.

Archives of Neurology , Volume 43 (6) – Jun 1, 1986

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1986.00520060007004
Publisher site
See Article on Publisher Site

Abstract

Abstract In Reply. —I do not wish to take an extreme position (even on a point so small), but I disagree on most counts. Separating an ophthalmoplegic-ataxic form of Guillain-Barré syndrome (GBS) from cases with obvious brain-stem signs emphasizes the unusual clinical features produced by peripheral pathology. I have seen scattered perivascular lymphocytes in the brain stem and spinal cord of mundane GBS cases; no doubt this occurs, but no central signs resulted in these cases. Perhaps a fleeting sensory level, Babinski's sign, or unusual neuroophthalmologic finding is explained by these lesions, but this is not brainstem encephalitis. There are also rare patients with inflammatory processes, usually chronic, involving both the brain and peripheral nerves (a patient of mine is described in this issue of the Archives1). The illness described by Bickerstaff2 and Al-Din et al3 is usually distinguishable by clinical signs from the similar Fisher's syndrome produced by GBS. References 1. De la Monte SM, Ropper AH, Dickersin GR, et al: Relapsing central and peripheral demyelinating diseases: Unusual pathologic features . Arch Neurol 1986;43:626-629.Crossref 2. Bickerstaff ER: Brainstem encephalitis: Further observations on a grave syndrome with benign prognosis . Br Med J 1957;1:1384-1387.Crossref 3. Al-Din AN, Anderson M, Bickerstaff ER, et al: Brainstem encephalitis and the syndrome of Miller Fisher: A clinical study . Brain 1982;105:481-495.Crossref 4. Bignami A, Servi M: Acute internal and external opthalmoplegia with muscle weakness . Lancet 1963;1:1110.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Jun 1, 1986

References