Controversy about Fisher's syndrome.

Abstract

To the Editor. —Allan Ropper 1 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's 3 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 colleagues 2 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