Features required for diagnosis |
Miller Fisher syndrome: |
Progressive, relatively symmetric ophthalmoplegia and ataxia by 4 weeks |
Hyporeflexia or areflexia |
Limb strength with 5 or 4 on the Medical Research Council scale |
Bickerstaff's brain stem encephalitis: |
Progressive, relatively symmetric ophthalmoplegia and ataxia by 4 weeks |
Either consciousness disturbance (coma, semicoma, or stupor) or pyramidal signs (hyperreflexia or pathological reflexes) |
Limb strength with 5 or 4 on the Medical Research Council scale |
Acute ophthalmoparesis: |
Progressive, relatively symmetric ophthalmoplegia by 4 weeks |
Neither ataxia nor limb weakness |
Features strongly supportive of the diagnosis for each condition |
A history of infectious symptoms within 4 weeks before the onset of neurological symptoms |
CSF albuminocytological dissociation |
Presence of anti-GQ1b IgG antibody |
Features that rule out the diagnosis |
Wernicke's encephalopathy, vascular disease involving the brain stem, multiple sclerosis, neuro-Behçet's disease, botulism, myasthenia gravis, brain stem tumour, pituitary apoplexy, vasculitis, and lymphoma |
Appendix |
Patients showing limb weakness (3 or less on the Medical Research Council scale), in addition to ophthalmoplegia and ataxia, were diagnosed as having overlapping Miller Fisher syndrome and Guillain-Barré syndrome. |
Patients showing limb weakness (⩽3 on the Medical Research Council scale), in addition to consciousness disturbance (coma, semicoma, or stupor) or pyramidal signs as well as ophthalmoplegia, were diagnosed as having overlapping Bickerstaff's brain stem encephalitis and Guillain-Barré syndrome. |