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June 1986

Controversy About Fisher's Syndrome

Author Affiliations

Department of Medicine Kuwait University Box 24923 Alrazi, Kuwait

Arch Neurol. 1986;43(6):543. doi:10.1001/archneur.1986.00520060007003

To the Editor.  —Allan Ropper1 drew attention to recent controversy concerning the presence or absence of a central nervous system lesion in Fisher's syndrome. He cited the pathological examination of what he considered an "archetypal" case that had no brain-stem abnormalities at necropsy.2 If Miller Fisher's3 definition of the syndrome ("... characterized particularly by total external ophthalmoplegia, ataxia and loss of tendon reflexes... in which limb involvement was minimal or absent") is used, then Phillips and colleagues'2 case is hardly "archetypal." In addition to the complete ophthalmoplegia, their patient had clinical, neurophysiological, and pathological evidence of severe demyelinative polyneuropathy in the limbs, which is not a feature of Fisher's syndrome. Furthermore, the pathological report of Phillips and colleagues2 stopped short of explaining the ophthalmoplegia: "The distal portions of the third, fourth and sixth cranial nerves were not available for examination but no histological abnormality of their

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