Gökhan ÖZDEMİR, Hızır ULVİ, Recep AYGÜL, Recep DEMİR

Atipik Miller Fisher Sendromu Olgusu

Miller fisher sendromu nadir görülen, oftalmopleji, ataksi ve arefleksi kliniği ile seyreden,Guillain-Bare sendromunun bir varyantıdır. Atipik seyreden, dipleji fasiyale ve kuadriparezigelişen bir Miller fisher sendromu olgusu sunuldu.Daha önce sistemik bir hastalığı olmayan, aniden çift görme ve göz kapaklarında düşme olanve akşamları şikayetleri daha belirgin hale gelen 19 yaşında erkek hastanın yapılan nörolojikmuayenesinde; bilateral total oftalmopleji, sol gözde daha belirgin her iki göz kapağında pitozistespit edildi. Pupiller izokorik, ışık refleksi, kornea refleksi ve göz dibi muayenesi normaldi.Derin tendon refleksleri tüm ekstremitelerde alınmıyordu, pozisyon ve vibrasyon kaybolmuşve yürüyüş esnasında özellikle dönüşlerde belirgin ataksi vardı. Yatışının üçüncü günü diplejifasiyale ve kuadriparezi gelişti. Beşinci günü bakılan beyin omurilik sıvısı tetkikindealbuminositolojik disosiasyon saptandı. Kranial magnetik rezonans görüntüleme normal,fizostigmin testi negatif olan ve elektronöromyografi incelemesinde ağır aksonal kayıplı duysalpolinöropati tesbit edilen hastaya miller fisher sendromu tanısı kondu. Beş gün boyunca 400mg/kg/ gün intravenöz immunglobulin tedavisi uygulandı. 20 gün sonra kısmı şifa ile taburcuedilen hastanın 3 ay sonraki kontrolünde tamamen düzeldiği gözlendi.Atipik seyreden dipleji fasiyale ve kuadriparezi gelişen klinik olarak Myastenia Gravisi (MG)düşündüren bir miller fisher sendromu olgusu sunuldu ve literatür ışığında tartışıldı

Anahtar Kelimeler:

Miller Fisher sendromu, kuadriparezi, Myastenia Gravis

Atypical A Case Of Miller Fisher Syndrome

Miller Fisher Syndrome is a rare variant of Guillain Barre Syndrome characterised withophtalmoplegia, ataxia and areflexia. We present a case with Miller Fisher Syndrome with anatypical course who developed facial diplegia and quadriparesis.19 years old male patient who had no history of systemic disease had developed diplopia, pitozisand his complaints were said to worsen at the nights. İn the neurological examination we foundbilateral ophtalmoplegia, bilateral pitosis more obvious in the left eyelid. Pupils were isocoricand pupillary light reflex, corneal reflex and examination of the fundus were found to be normal.Deep tendon reflexes could not be observed in all limbs. Position and vibration sense had beenlost and ataxia was obvious while walking especially turning around himself. In the third dayafter his admittance he developed facial diplegia and quadriparesis. In the cerebrospinal fluidin the 5 th day of the admittance we found albuminocytologic dissociation. Cranial MRI wasnormal and physostigmin test was negative and in electromyography we observed sensorypolyneuropathy with severe axonal degeneration and with these findings he had the diagnosisof Miller Fisher Syndrome. We administered intravenosus immunoglobulin treatment at thedose of 400 mg/kg/daily. He was discharged with partial remission at the 20 th day of admittanceand had full remission at his control at the 3 rd month of discharge.We presented a case with Miller Fisher Syndrome which is clinically similar to MyastheniaGravis with an atypical course having developed facial diplegia and quadriparesis and wasdicussed in the light of the literature

Keywords:

Miller Fisher Syndrome, quadriparesis, Myasthenia Gravis,

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