A rare mimic of acute stroke: rapidly progressing Miller-Fisher Syndrome to acute motor and sensory axonal neuropathy variant of Guillain-Barre Syndrome.

Ophthalmoplegia, ataxia and areflexia characterise the clinical triad of Miller-Fisher Syndrome (MFS). When the disease presents acutely, it can mimic posterior circulation stroke. We describe a case of an adult patient presenting with sudden dizziness, diplopia, vomiting, and loss of balance. She was initially managed as a case of a brainstem stroke, but the progression of craniopathies without deterioration in sensorium coupled with areflexia clinched the diagnosis of MFS two days into her admission. On the third day, her MFS progressed rapidly to acute motor and sensory axonal neuropathy (AMSAN) variant of Guillain-Barre Syndrome, a rare occurrence in patients with MFS, with only four reported cases including our own. Among the four cases, ours is the only one still non-ambulatory eight months after the initial onset of symptoms. The case highlights the importance of early recognition of MFS in patients with ophthalmoplegia and ataxia despite initially normal reflexes.

Pulmonary Embolism from Cement Augmentation of the Vertebral Body.

Pulmonary cement embolism (PCE) can follow cement augmentation procedures for spine fractures due to osteoporosis, traumatic injuries, and painful metastatic lesions. PCE is underreported and it is likely that many cases remain undiagnosed. Risk factors for PCE have been identified, which can help alert clinicians to patients likely to develop the condition, and there are recommended techniques to reduce its incidence. Most patients with PCE are asymptomatic or only develop transient symptoms, although a few may exhibit florid cardiorespiratory manifestations which can ultimately be fatal. Diagnosis is mainly by radiographic means, commonly using simple radiographs and computed tomography scans of the chest with ancillary tests that assess the patient's cardiorespiratory condition. Management depends on the location and size of the emboli as well as the patient's symptomatology. The aim of this review is to raise awareness of the not uncommon complications of PCE following vertebral cement augmentation and the possibility of serious sequelae. Recommendations for the diagnosis and management of PCE are presented, based on the most recent literature.