Clinical features and differential diagnosis of Miller-Fisher syndrome and Bickerstaff's brainstem encephalitis / 临床神经病学杂志

ABSTRACT

Objective To study the clinical characteristics and differential diagnosis of Miller-Fisher syndrome (MFS) and Bickerstaff's brainstem encephalitis (BBE).Methods The clinical data of 12 patients with diagnosis of MFS and 15 patients with diagnosis of BBE were analyzed retrospectively.Results In MFS group, the patients showed diplopia (12 cases), loss of pupillary light reflex (3 cases), peripheral facial paralysis (7 cases), hydroposia bucking (1 case), weakness of limbs (6 cases), sensory disability (4 cases) and ataxia (10 cases). In BBE group, the patients presented with diplopia (11 cases), central facial palsy (4 cases), tinnitus (4 cases), hydroposia bucking (6 cases), weakness of limbs (10 cases), sensory disability (2 cases), ataxia (10 cases), somnolence or coma (5 cases) and positive Babinski's sign (9 cases). CSF examination showed elevation of protein in 10 patients from BBE group and 10 patients from MSF group, however, leucocytosis was found in 6 cases from BBE group and 2 cases from MSF group. There were 4 patients of MFS and 1 patient of BBE with abnormal results of electromyogram (EMG) examination. 6 patients in BBE group had abnormal results of CT or MRI examinations, and the lesions mainly located in brainstem, thalamus and so on. Both groups had good prognosis after therapies. Conclusions MFS and BBE have similar and overlapped clinical characteristics. This indicates that these two diseases are closely related and may form a continuous spectrum. The main identifications of BBE are conscious disturbance, positive reflex of Babinski's sign and abnormal imaging results in some patients.