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May 1995

Neoplastic Meningitis Presenting With Ophthalmoplegia, Ataxia, and Areflexia (Miller-Fisher Syndrome)

Author Affiliations

via Albertoni 15 40138 Bologna Italy

Arch Neurol. 1995;52(5):443-444. doi:10.1001/archneur.1995.00540290021008

Diffuse leptomeningeal infiltration by neoplastic cells is a well-recognized manifestation of malignant tumors. The usual clinical presentation is subacute or chronic meningitis with multifocal cranial and spinal nerve root symptoms and a variable degree of encephalopathy. We describe two patients with carcinomatous and leukemic meningitis mimicking Miller-Fisher syndrome.1

Report of Cases. 

—Case 1.  —A 73-year-old woman underwent a gastrectomy for cancer in July 1993. Six months later, she was admitted for diplopia, unsteadiness, and intermittent occipital headache that had started 3 days before. Neurologic examination disclosed bilateral abducens nerve paralysis, severe ataxia, and global areflexia. An electroencephalogram and a computed tomographic scan of the brain were normal. Cerebrospinal fluid (CSF) examination showed elevated proteins (0.66 g/L) with 1 cell per milliliter, and a low glucose level (0.34 g/L). Cytologic examination of the CSF disclosed adenocarcinomatous cells. Despite chemotherapy, the patient's condition became worse with rapid deterioration and death 20

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