Supranuclear eye movement disorders in Fisher's syndrome of ophthalmoplegia, ataxia, and areflexia. Report of a case and literature review

Abstract

Eye movements in a patient with Fisher's syndrome were examined clinically and documented photographically when palsies were most severe and on repeated occasions during the recovery period. Two recordings of horizontal eye movements were made using the infrared reflection method. Particular attention was paid to signs indicating supranuclear eye movement disorders. We also reviewed cases in which signs suggesting brain-stem involvement were reported. Mild ptosis in the presence of severe ophthalmoplegia, preservation of Bell's phenomenon despite paralysis of voluntary upward gaze, conjugate palsies of vertical gaze, and horizontal dissociated nystagmus have been found relatively often. Convergence spasm was reported only once, however, and there were no prior reports of rebound nystagmus or vertical vestibulo-ocular reflex disorder.