Sindrome de Miller Fisher: relato de um caso

Resende, Luiz Antonio De Lima; Battistuta, Reynaldo José Rios; Sato, Takassu; Bortoli, Nelson Antonio de

doi:10.1590/S0004-282X1984000200011

Resumos

Os autores relatam caso de paciente com 27 anos de idade com oftalmoplegia externa, anisocoria, ataxia, arreflexia profunda, disfagia, disfonia, paralisia facial periférica bilateral, hipopalestesia e discreta hipoestesia táctil palmo-plantar. O quadro teve início 10 dias após virose de vias aéreas superiores e ocorreu rápida melhora após terapêutica com prednisona. Os achados do exame neurológico e dos subsidiários são compatíveis a alterações centrais e periféricas.

The authors report a case of a 27 year old male patient who has exhibited external ophthalmoplegia, anisocoria, ataxia, absent deep reflexes, dysphagia, dysphonia, bilateral peripheral facial paralysis, hypopallesthesia and a mild sensory impairment of the four extremities. In addition, his cerebrospinal fluid showed albuminocytologic dissociation. The otoneurologic examination showed important findings. These symptoms began ten days after a "cold", and quickly subsided after prednisone therapy. Two months after the onset of clinical features, just a deep apendicular areflexia was detected on his neurological examination. The neurological signs and complementary laboratory findings suggest that both central and peripheral alterations are responsible for the clinical manifestations.

Sindrome de Miller Fisher: relato de um caso

Syndrome of Miller Fisher: a case report

Luiz Antonio De Lima Resende^I; Reynaldo José Rios Battistuta^I; Takassu Sato^II; Nelson Antonio de Bortoli^III

^IMédico Residente. Departamento de Neuropsiquiatria e Psicologia Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo

^IIProfessor Assistente-Doutor. Departamento de Neuropsiquiatria e Psicologia Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo

^IIIMédico Assistente. Departamento de Neuropsiquiatria e Psicologia Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo

RESUMO

Os autores relatam caso de paciente com 27 anos de idade com oftalmoplegia externa, anisocoria, ataxia, arreflexia profunda, disfagia, disfonia, paralisia facial periférica bilateral, hipopalestesia e discreta hipoestesia táctil palmo-plantar. O quadro teve início 10 dias após virose de vias aéreas superiores e ocorreu rápida melhora após terapêutica com prednisona. Os achados do exame neurológico e dos subsidiários são compatíveis a alterações centrais e periféricas.

SUMMARY

The authors report a case of a 27 year old male patient who has exhibited external ophthalmoplegia, anisocoria, ataxia, absent deep reflexes, dysphagia, dysphonia, bilateral peripheral facial paralysis, hypopallesthesia and a mild sensory impairment of the four extremities. In addition, his cerebrospinal fluid showed albuminocytologic dissociation. The otoneurologic examination showed important findings. These symptoms began ten days after a "cold", and quickly subsided after prednisone therapy. Two months after the onset of clinical features, just a deep apendicular areflexia was detected on his neurological examination. The neurological signs and complementary laboratory findings suggest that both central and peripheral alterations are responsible for the clinical manifestations.

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Trabalho realizado no Departamento de Neuropsiquiatria e Psicologia Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo.

Departamento de Neuropsquiatria e Psicologia Médica - Faculdade de Medicina de Ribeirão Preto - 14.100, Ribeirão Preto, SP - Brasil

1. AL-DIN, A. N.; ANDERSON, M.; BICKERSTAFF, E. R. & HARVEY, I. -Brainstem encephalitis and the syndrome of Miller Fisher - A clinical study. Brain 105:481, 1982.
2. COLLARD, M.; MATHE, J. F.; GUIHENNEUC, P.; COQUILLAT, C; EBER, A. M. & RUH, D. - Syndrome de Fisher. Origine périphérique ou centrale? Rev. neurol. (Paris) 134:325, 1975.
3. ELIZAN, T. S.; SPIRE, J. P.; ANDIMAN, R. M.; BAUGHMAN, F. A. & LLOYD-SMITH, D. L. - Syndrome of acute idiopathic ataxia and areflexia. Neurology (Minneapolis) 21:281, 1971.
4. FISHER, M. - An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). New Engl. J. Med. 255-57, 1956.
5. GOODWIN, R. F. & POSER, C. M. - Ophthalmoplegia, ataxia and areflexia. J. amer. med. Assoc, 186:258, 1963.
6. MUNSAT, T. L. & BARNES, L. R. - Relation of multiple cranial nerve dysfunction to the Guillain-Barré syndrome. J. Neurol. Neurosurg. Psychiat. 28:115, 1965.
7. RICHTER, R. B. - The ataxic form of polyradiculoneuritis (Landry-Guillain-Barré syndrome). J. Neuropath, exp. Neurol. 21:171, 1962.
8. SMITH, J. L. & WALSH, F. B. - Syndrome of external ophthalmoplegia, ataxia and areflexia (Fisher). Arch. Ophthal. 58:109, 1957.
9. WILLIAMS, D.; BRUST, J. C. M.; ABRAHMS, G.; CHALLENOR, Y. & DEVE-REAUX, M. - Landry-Guillain-Barré syndrome with abnormal pupils and normal eye movements: a case report. Neurology (Minneapolis) 29:1033, 1979.

Datas de Publicação

Publicação nesta coleção
13 Ago 2012
Data do Fascículo
Jun 1984

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[1] 1. AL-DIN, A. N.; ANDERSON, M.; BICKERSTAFF, E. R. & HARVEY, I. -Brainstem encephalitis and the syndrome of Miller Fisher - A clinical study. Brain 105:481, 1982.

[2] 2. COLLARD, M.; MATHE, J. F.; GUIHENNEUC, P.; COQUILLAT, C; EBER, A. M. & RUH, D. - Syndrome de Fisher. Origine périphérique ou centrale? Rev. neurol. (Paris) 134:325, 1975.

[3] 3. ELIZAN, T. S.; SPIRE, J. P.; ANDIMAN, R. M.; BAUGHMAN, F. A. & LLOYD-SMITH, D. L. - Syndrome of acute idiopathic ataxia and areflexia. Neurology (Minneapolis) 21:281, 1971.

[4] 4. FISHER, M. - An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). New Engl. J. Med. 255-57, 1956.

[5] 5. GOODWIN, R. F. & POSER, C. M. - Ophthalmoplegia, ataxia and areflexia. J. amer. med. Assoc, 186:258, 1963.

[6] 6. MUNSAT, T. L. & BARNES, L. R. - Relation of multiple cranial nerve dysfunction to the Guillain-Barré syndrome. J. Neurol. Neurosurg. Psychiat. 28:115, 1965.

[7] 7. RICHTER, R. B. - The ataxic form of polyradiculoneuritis (Landry-Guillain-Barré syndrome). J. Neuropath, exp. Neurol. 21:171, 1962.

[8] 8. SMITH, J. L. & WALSH, F. B. - Syndrome of external ophthalmoplegia, ataxia and areflexia (Fisher). Arch. Ophthal. 58:109, 1957.

[9] 9. WILLIAMS, D.; BRUST, J. C. M.; ABRAHMS, G.; CHALLENOR, Y. & DEVE-REAUX, M. - Landry-Guillain-Barré syndrome with abnormal pupils and normal eye movements: a case report. Neurology (Minneapolis) 29:1033, 1979.