Brain stem encephalitis and the syndrome of Miller Fisher. A clinical study. By Amir Najim Al-Din, Milne Anderson, Edwin R. Bickerstaff and Ian Harvey (From the Midland Centre for Neurosurgery, Smethwick, West Midlands, UK). Brain 1982: 105; 481—495; and Bickerstaff's brainstem encephalitis: clinical features of 62 cases and a subgroup associated with Guillain-Barré syndrome. By Masaaki Odaka, Nobuhiro Yuki, Mitsunori Yamada, Michiaki Koga, Toshihiko Takemi, Koichi Harata and Satoshi Kuwabara (From the University School of Medicine, Tochigi; Brain Research Institute, Niigata University; St Luke's International Hospital, Toyko; and Chiba University School of Medicine, Chiba, Japan) Brain 2003: 126; 2279–2290.

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Abstract
In 1957, Edwin Bickerstaff (1920–2007) followed up on three cases of mesencephalitis and rhomboencephalitis he had reported 6 years earlier with Philip Cloake (1890–1969), describing as a definitive syndrome eight patients with acute symmetrical ophthalmoplegia, other cranial nerve palsies and ataxia (Br Med J 1957: 1; 1384–1387). The team from Birmingham opens their new analysis of this disorder by stating unambiguously that ‘brainstem encephalitis includes the syndrome of ophthalmoplegia, ataxia and hyporeflexia’. The typical form is characterized by acute progressive ophthalmoplegia, involvement of other cranial nerves, ataxia and hyporeflexia, no significant motor or sensory deficit in the limbs and usually with full recovery. After the appearance of Charles Miller Fisher's paper in 1956 (New Engl J Med 1956: 255; 57–65) in which, reporting three cases and building on the suggestion by James Collier (1870–1935) that the Guillain–Barré syndrome may show external ophthalmoplegia with or without limb paralysis and in which Dr Fisher emphasizes the increase in cerebrospinal fluid protein without pleocytosis, the style of case series has been to designate this syndrome as a variant of acute post-infectious polyneuritis. With Edwin Bickerstaff as co-author, Amir Al-Din and colleagues now aim to show that the syndrome of acute ophthalmoplegia, ataxia and areflexia is distinct from the Guillain–Barré syndrome and the pathology does indeed affect the brainstem.

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