Brainstem encephalitis or the Miller Fisher syndrome--a variant of acute idiopathic polyneuropathy. Case reports

A syndrome comprising ophthalmoplegia, ataxia and areflexia was described by Miller Fisher in 1956. While some consider it to be a benign variety of acute idiopathic (Guillain-Barré) polyneuropathy, there are reports of the need for ventilatory support and of the benefits of plasmapheresis. Two further cases are described. The first patient was seen in 1972 and was well 10 years later. The second patient gave cause for concern and might have benefitted from plasmapheresis, but nevertheless he recovered spontaneously. Miller Fisher believed that the pathological process was located in the peripheral nerve, but others have produced evidence that the cranial nerve nuclei and central connections within the brainstem are involved.