Martins Hélio, Mendonça Joana, Paiva David, Fernandes Carlos, Cotter Jorge
Hospital da Senhora da Oliveira, Guimarães, Portugal.
Eur J Case Rep Intern Med. 2020 Jan 27;7(2):001387. doi: 10.12890/2020_001387. eCollection 2020.
A 55-year-old Caucasian male presented initially to the emergency room (ER) reporting myalgia, chills and fever. Physical examination and laboratory tests were unremarkable and he was discharged with symptomatic care. He returned to our ER 2 weeks later reporting dizziness, loss of balance, blurred vision, mild dysarthria and bilateral hand paraesthesia. On examination, he presented complete bilateral ophthalmoplegia, mild dysarthria, left finger-to-nose dysmetria, ataxia, areflexia and bilateral hand hypoaesthesia without fever. Blood tests and head computed tomography were normal. The patient was admitted to the Internal Medicine department. On the second day on the ward, the patient presented dysphagia. A head magnetic resonance angiogram showed no signs of ischaemia or vascular disease and a lumbar puncture was performed but no pleocytosis, albumin-cytological dissociation or hypoglycorrhachia was present. Despite the normal results we suspected a Guillain-Barré syndrome variant, and started treatment with intravenous immunoglobulin (IVIG) at a dose of 400 mg per kilogram which continued for 5 days with immediate neurological improvement. We present a rare overlapping case of Miller Fisher syndrome and the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome.
The overlap of Miller Fisher syndrome and pharyngeal-cervical-brachial variants of Guillain-Barré syndrome are rarely described in the literature but should be considered when multiple cranial nerves are involved with normal neuroimaging results, even with normal cerebrospinal fluid analysis.Due to similar clinical presentation, a misdiagnosis of cerebral ischaemia, botulism or ocular myasthenia gravis can delay treatment and put patients at risk.In its natural history, this syndrome evolves to respiratory arrest and death, but with accurate diagnosis and prompt treatment, the prognosis improves considerably.
一名55岁的白种男性最初到急诊室就诊，报告有肌痛、寒战和发热。体格检查和实验室检查均无异常，他接受了对症治疗后出院。两周后他再次回到我们的急诊室，报告有头晕、平衡失调、视力模糊、轻度构音障碍和双手感觉异常。检查时，他出现完全性双侧眼肌麻痹、轻度构音障碍、左手指鼻试验辨距不良、共济失调、腱反射消失和双手感觉减退，无发热。血液检查和头部计算机断层扫描均正常。患者被收入内科病房。在病房的第二天，患者出现吞咽困难。头部磁共振血管造影未显示缺血或血管疾病迹象，进行了腰椎穿刺，但未发现细胞数增多、蛋白 - 细胞分离或脑脊液低糖。尽管结果正常，我们仍怀疑是吉兰 - 巴雷综合征变异型，并开始以每千克400毫克的剂量静脉注射免疫球蛋白（IVIG）治疗，持续5天，患者神经功能立即得到改善。我们报告了一例罕见的米勒 - 费希尔综合征与吉兰 - 巴雷综合征咽颈臂变异型重叠病例。
米勒 - 费希尔综合征与吉兰 - 巴雷综合征咽颈臂变异型的重叠在文献中很少被描述，但当多组颅神经受累且神经影像学结果正常，即使脑脊液分析正常时，也应考虑这种情况。由于临床表现相似，脑缺血、肉毒中毒或眼肌型重症肌无力的误诊会延误治疗并使患者处于危险之中。在其自然病程中，该综合征会发展为呼吸骤停和死亡，但通过准确诊断和及时治疗，预后会有显著改善。
