李刚;宋佳;庞咪;马明明;徐长水;张杰文;

• 1:河南省人民医院暨郑州大学人民医院河南大学人民医院神经内科

摘要(Abstract)：

目的研究老年Miller-Fisher综合征(MFS)患者的临床和电生理特征,并分析其预后。方法对9例老年MFS患者的临床表现、辅助检查、治疗和预后进行回顾性总结分析。结果本组男女比例4:5,患病年龄(68.3±4.1)岁,病程(19.2±9.9)d,发病主要在春冬季节,有呼吸道感染前驱史者3例,首发症状主要为头晕、头痛、眼睑下垂、复视、行走不稳和肢体麻木无力,起病至达峰平均(2.7±2.8)d;患者均有眼肌麻痹、共济失调和腱反射减弱或消失,眼胀痛5例,眼内肌受累2例,面神经受累4例,舌咽、迷走神经受累3例,四肢肌力减退3例,远端浅感觉减退或消失6例,自主神经受累3例;血清抗GQ1b抗体阳性5例,脑脊液示蛋白细胞分离6例,四肢肌电图异常7例,主要表现为感觉神经传导受累5例;患者应用激素和(或)免疫球蛋白治疗,头痛、眼胀痛、肢体麻木症状最早改善,眼外肌麻痹、共济失调分别在(2.5±1.5)d、(6.3±3.8)d时开始改善,腱反射异常在2³周出院时无明显恢复;患者住院(15.0±4.6)d,出院时均好转。结论老年MFS临床表现多样,肌电图主要表现为感觉神经传导受累,血清抗GQ1b抗体有助于诊断,激素和(或)免疫球蛋白治疗后好转。

关键词(KeyWords)： Miller-Fisher综合征;老年;临床;神经电生理

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 李刚;宋佳;庞咪;马明明;徐长水;张杰文;

参考文献(References)：

• [1]Salehi N,Choi ED,Garrison RC,et al.A Case of Miller Fisher Syndrome,Thromboembolic Disease,and Angioedema:Association or Coincidence?[J].Am J Case Rep,2017,18:52-59.
• [2]Shahrizaila N,Goh KJ,Kokubun N,et al.Sensory nerves are frequently involved in the spectrum of fisher syndrome[J].Muscle Nerve,2014,49(4):558-563.
• [3]Zhang G,Li Q,Zhang R,et al.Subtypes and Prognosis of Guillain-BarréSyndrome in Southwest China[J].PLoS One,2015,10(7):e0133 520.
• [4]Wakerley BR,Kokubun N,Funakoshi K,et al.Clinical classification of 103 Japanese patients with GuillainBarrésyndrome[J].J Neurol Sci,2016,369:43-47.
• [5]Wang L,Shao C,Yang C,et al.Association of anti-gangliosides antibodies and anti-CMV antibodies in GuillainBarrésyndrome[J].Brain Behav,2017,7(5):e00690.
• [6]Bukhari S,Taboada J.A Case of Miller Fisher Syndrome and Literature Review[J].Cureus,2017,9(2):e1 048.
• [7]Wang SH,Zhang YB,Xie YC,et al.An 85-year-old woman with Miller Fisher syndrome[J].Pak J Med Sci,2013,29(5):1 288-1 289.
• [8]Sinmaz N,Nguyen T,Tea F,et al.Mapping autoantigen epitopes:molecular insights into autoantibody-associated disorders of the nervous system[J].J Neuroinflammation,2016,13(1):219.
• [9]Mu1iz AE.Multiple cranial nerve neuropathies,ataxia and,areflexia:Miller Fisher syndrome in a child and review[J].Am J Emerg Med,2017,35(4):661.e1-661.e4.
• [10]Umapathi T,Tan EY,Kokubun N,et al.Non-demyelinating,reversible conduction failure in Fisher syndrome and related disorders[J].J Neurol Neurosurg Psychiatry,2012,83(9):941-948.