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目的探讨Miller-Fisher综合征的临床特点。方法回顾性分析5例Miller-Fisher综合征患者发病年龄、发病形式、首发症状、临床表现、影像学特征、脑脊液检查结果及预后情况,并结合文献进行临床分析。结果Miller-Fisher综合征发病年龄为17～73岁;多为亚急性起病;首发症状主要为视物成双和四肢无力;主要神经系统症状为视物成双、眼球运动障碍、声音嘶哑、饮水呛咳及四肢无力、麻木。主要神经系统体征为眼外肌麻痹,水平性眼震,周围性面瘫,共济失调,深、浅感觉减退,腱反射减弱或消失。辅助检查:脑脊液(CSF)蛋白升高5例,CSF细胞轻度升高3例。肌电图示神经源性损害3例。脑CT和MRI检查均未发现异常。予人免疫球蛋白、营养神经、改善微循环、脱水及对症支持治疗可有效缓解病情。治疗10d症状即改善,3个月内5例患者临床症状消失,但仍有腱反射减弱或消失。结论对于感染、接种疫苗后出现复视、眼外肌麻痹、面瘫、饮水呛咳、四肢麻木无力、共济失调、腱反射消失等神经系统局灶体征,应高度怀疑Miller-Fisher综合征,经人免疫球蛋白、营养神经、改善微循环、脱水及对症支持治疗后,大多数患者预后良好。
Objective To investigate the clinical features of Miller-Fisher syndrome. Methods Retrospective analysis of 5 cases of Miller-Fisher syndrome patients age of onset, the incidence of the disease, the first symptom, clinical manifestations, imaging features, cerebrospinal fluid examination results and prognosis, combined with the literature for clinical analysis. Results The age of onset of Miller-Fisher syndrome was 17-73 years. Mostly subacute onset; the first symptom was mainly double as visual acuity and weakness of limbs; the main neurological symptoms were double as visual acuity, eye movement disorders, hoarseness, Choking cough and limb weakness, numbness. The main neurological signs of extraocular muscle paralysis, horizontal nystagmus, peripheral facial paralysis, ataxia, deep, shallow sensory decline, reduced or disappeared tendon reflex. Auxiliary examination: Cerebrospinal fluid (CSF) protein increased in 5 cases, CSF cells were slightly elevated in 3 cases. Electromyography showed 3 cases of neurogenic damage. Brain CT and MRI examination showed no abnormalities. Human immune globulin, nourishing nerves, improve microcirculation, dehydration and symptomatic and supportive treatment can effectively alleviate the condition. After 10 days of treatment, the symptoms improved, and in 5 months, the clinical symptoms disappeared in 5 cases, but the tendon reflex disappeared or disappeared. Conclusions Miller-Fisher syndrome should be highly suspected for infection and focal neurological signs such as diplopia, extraocular muscle paralysis, facial paralysis, choking water, numbness in limbs, ataxia, and disappearance of tendon reflexes after infection. Human immunoglobulin, nourishing nerves, improve microcirculation, dehydration and symptomatic and supportive treatment, the majority of patients with good prognosis.