We report on three elderly patients with stroke-like onset of atypical Miller Fisher syndrome (MFS). The serum titer of anti-GQ1b IgG was markedly elevated in these patients. Their prognoses were sufficiently good with immunoadsorption therapy with or without intravenous immune globulin (IVIg) therapy. However, some neurological findings were not characteristic of typical MFS. Patient 1 suffered from prolonged dysesthesia in her left extremities, and Patients 2 and 3 showed no ataxia. Moreover, complete bilateral gaze limitation is rare in MFS. The sudden stroke-like onset along with the gaze limitation of these patients suggests that the unexpected elevation in the serum titer of anti-GQ1b IgG due to unknown immune dysregulation might have severely affected the third, fourth, and sixth nerves and this potent antibody rapidly attacked these nerves and induced stroke-like clinical features and complete ophthalmoplegia.
Cerebrovascular accident ; Miller Fisher Syndrome ; Right and left ; Serum ; Atypical

Purpose: To create flow charts of eating and swallowing that make it easy to identify the cases requiring professional treatment including dysphagia rehabilitation during oral intake.Subjects: 28 patients (mean age: 78.7±11.3 years) with dysphagia who underwent videofluorography (hereinafter “VF”).Methods: We conducted various tests such as Repetitive Salvia Swallowing Test (RSST), Modified Water Swallowing Test (MWST) and Food Test (FT), and studied relationships between VF findings and Fujishima's grade of eating and swallowing capability.Results: After the examination of th results of RSST (sensitivity: 0.83, specificity: 0.22), MWST (sensitivity: 0.56, specificity: 0.72), FT (sensitivity: 0.33, specificity: 0.75), VF and grade of eating and swallowing capability of Fujishima, the use of MWST and FT was appropriate. However, four cases in which the results of MWST and FT were over the cut-off value had misswallowed water and food. We created the flowcharts considering that all of those 4 cases are also the cases that suffered from the consequences of cerebral strokes.

  When subacute elderly patients are transferred from an acute hospital to a rehabilitation facility, the likelihood is that the environmental change will decrease the patients' ability to perform the basic activities of daily living (ADLs). In this study, we assessed the effects of the ambient changes on ADLs by the use of the Barthel Index, the reliability as well as validity of which is rated high for assessing the patient's fundamental ability. Our subjects consisted of the patients with hemiplegia who had undergone medical treatment of stroke and those who had been operated on for femoral neck fracture (FNF) in Toride Kyodo General Hospital. They were transferred to the convalescent rehabilitation ward (CRW) of Aida Memorial Rehabilitation Hospital, affiliated with our hospital. We compared the BI scores given to the patients by physical, occupational and speech therapists, when discharged from our hospital, and those scores given by nurses within one week after the patients moved to the CRW. Differences between BI scores given at Toride Hospital and those at the rehabilitation hospital averaged -5.9±16.0 points for stroke patients and -7.3±14.1 pointsfor FNF patients. Spearman's rank correlation coefficient of BI scores in the acute hospital and in the CRW for stroke patients was 0.91 (p<0.001) and 0.69 (p<0.001) for FNF. There was no significant difference in changes in BI scores between stroke and FNF. However, there was a tendency for the patients' functional ability in daily living to be assessed lower in the FNF patients than in the stroke patients. This was probably because the former were older than the latter on the average. The average age of the FNF patients was 81.4 years and that of the stroke patients was 68.5 years.