[Fisher's syndrome with profound hypotension].

A case of Fisher's syndrome was described in which profound hypotension was encountered. A 70-year-old previously healthy female developed diplopia and unsteady gait following an upper respiratory infection. On admission, her blood pressure was 140/60 mmHg. Adduction of the left eye and elevation of the right eye were limited. Other cranial nerve functions and muscle strength were intact. She had gait ataxia with negative Romberg sign. Tendon reflexes were hypoactive. The cerebrospinal fluid, electrocardiography, and cranial MR imaging were unremarkable. Her serum had a high titer of IgG anti-body. After admission she developed bilateral internuclear ophthalmoplegia and severe gait ataxia. During double filtration plasmapheresis, her systolic pressure fell down to 60 mmHg. To maintain her systolic pressure between 90 and 120-mmHg supine, infusion of lactated Ringer solution (3,000-3,500 ml/day), dopamine hydrochloride (10-12 micrograms/kg/min), and norepinephrine (50-90 ng/kg/min) was needed for 3 weeks. There was no evidence of denervation supersensitivity. Echocardiography demonstrated normal cardiac output, suggesting that decreased vascular resistance was responsible for her hypotension. In Guillain-Barré syndrome, cardiovascular dysautonomia is frequently encountered and is occasionally related to sudden death. In contrast, Fisher's syndrome with cardiovascular dysautonomia has been rarely reported. Cardiovascular functions should be monitored in every patient with Fisher's syndrome.