Clinical analysis of 4 patients with acute progressive ophthalmoplegia and literature review

Objective To investigate the clinical diagnosis, differentiate diagnosis and prognosis of patients with acute progressive ophthalmoplegia. Methods A retrospective analysis on the clinical manifestation, laboratory test, diagnosis, treatment and prognosis of 4 patients with acute progressive ophthalmoplegia, admitted to our hospital from January 2014 to March 2014, was performed and the related literatures were reviewed. Results The 4 patients were characterized by complete ophthalmoplegia, facial palsy and spinal nerve palsy. Two had heterocyst in cytological checkup of cerebrospinal fluid with positive meningeal irritation sign, therefore, they were diagnosed as having meningeal carcinomatosis (MC); they refused treatment, one died quickly and the other deteriorated gradually. The third patient was diagnosed as having Bickerstaff brainstem encephalitis (BBE) with conscious disturbance, bulboparalysis and accessory nerve palsy who was treated with double plasmapheresis and glucocorticoid therapy and recovered well. The fourth one was diagnosed as Miller-Fisher syndrome (MFS) and combined with Guillain-Barre syndrome (GBS), treated with human immunoglobulin at dosage of 0.4 g/(kg.d) and recovered after three weeks. Conclusions The clinical manifestations of MC, BBE, MFS and GBS may show acute progressive ophthalmoplegia which may be confused and difficult to diagnose. Examination of cerebrospinal fluid is still a very useful method to help the diagnosis. Prognosis of MC is bad and the others are good. Plasmapheresis and human immunoglobulin are useful to BBE, MFS and GBS. Key words: Ophthalmoplegia; Diagnosis; Differentiate diagnosis; Prognosis