ABSTRACT
In four patients with bacterial meningitis a primary intranasal encephalocele was found as portal of entry. In two of the cases the malformation had been misdiagnosed as a nasal polyp and operated upon. In two patients a cerebrospinal fluid fistula developed spontaneously at the age of 54 years. None of the patients had associated symptoms indicating the presence of a cleft. Encephaloceles can be readily visualized by computed tomography particularly in coronal sections. The treatment of choice is transcranial surgical repair.
Subject(s)
Cerebrospinal Fluid Rhinorrhea/complications , Encephalocele/complications , Meningitis, Bacterial/etiology , Adolescent , Cerebrospinal Fluid Rhinorrhea/diagnosis , Cerebrospinal Fluid Rhinorrhea/surgery , Encephalocele/diagnosis , Encephalocele/surgery , Female , Humans , Male , Meningitis, Aseptic/diagnosis , Meningitis, Aseptic/etiology , Meningitis, Bacterial/diagnosis , Meningitis, Pneumococcal/diagnosis , Meningitis, Pneumococcal/etiology , Middle Aged , Streptococcal Infections/diagnosis , Streptococcal Infections/etiology , Tomography, X-Ray ComputedABSTRACT
Miller Fisher's syndrome is characterized by the symptomtrias of ophtalmoplegia, ataxia and areflexia. Five cases of Miller Fisher syndrome are presented.; the nosological position of this disorder is reviewed. Involvement of brainstem is present in some cases--but obviously facultative.
Subject(s)
Cerebellar Ataxia/etiology , Ophthalmoplegia/etiology , Reflex, Abnormal/physiology , Aged , Brain Stem/physiopathology , Cerebellar Ataxia/physiopathology , Female , Humans , Male , Middle Aged , Neurologic Examination , Ophthalmoplegia/physiopathology , SyndromeABSTRACT
The triad of ataxia, areflexia and ophthalmoplegia was first described as a variant of the Guillain-Barre syndrome in 1932 by Collier. In 1956, Miller Fisher reported three patients with ataxia, areflexia, and ophthalmoplegia as a separate entity. Since then, 223 cases of Miller Fisher syndrome have been published. The male/female ratio is 2:1 with a mean age of 43.6 years at the onset of the disease. A viral infection preceded the neurological symptoms in 71.8% of cases with an average symptom-free interval of 10 days. First symptoms were diplopia (38.6%) or ataxia (20.6%). An areflexia was present in 81.6% of cases. Cranial nerves other than the oculomotor nerves were involved in 127 cases (56.9%): cranial nerves 7 (45.7%), 9 and 10 (39.9%), and 12 (13%) were involved. In 53 cases a tetraparesis occurred. An elevated protein value was present in 134 patients (64.4%); cerebrospinal fluid findings were normal in 56 patients. Eighteen patients showed a mild pleocytosis. Besides the cerebellar type of ataxia, initial disturbances of consciousness (n = 8), supranuclear oculomotor signs (n = 22), and pathology findings in electroencephalography (n = 38), computed tomography (n = 8), and magnetic resonance imaging (n = 2) were reported as evidence for a central nervous system involvement in the Miller Fisher syndrome. The prognosis of Miller Fisher syndrome was good--recovery occurred after a mean time period of 10.1 weeks. Residual symptoms were present in 74 cases (33.2%), and a recidivism of the Miller Fisher syndrome was reported in seven patients. Eight patients died. Of six patients with autopsy findings, four exhibited central nervous system lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
