From C. Miller Fisher to MRI

C. Miller Fisher has strongly influenced the neurologic evaluation of stroke patients. Many of his outstanding contributions are products of his clinical observations and pathologic correlations. Earlier in his career, Miller Fisher1 reviewed cases with hemorrhagic infarcts that presented in association with atrial fibrillation, in which the autopsies also demonstrated infarcts in the spleen and kidneys. He hypothesized that the ischemic stroke mechanism could be related to embolism from the heart, a more proximal source than the cerebral vessels, presuming that the embolic occlusion in the major cerebral arteries had broken up and was no longer evident.1 During the following years, the Harvard Cooperative Stroke Registry standardized Miller Fisher's approach to evaluation of stroke patients using the then-new CT technology.2 Mohr and Caplan, together with other stroke neurologists, started the new era of clarification of stroke mechanisms and classification of stroke syndromes and subtypes.2 However, it soon became clear that many ischemic stroke patients remained whose strokes occurred without a clear mechanism, despite the use of best diagnostic tools at that time. A category of ischemic stroke of undetermined …