A Case of Miller Fisher Syndrome and Literature Review

Abstract

Miller Fisher syndrome (MFS) was first recognized by James Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. Later, it was described in 1956 by Charles Miller Fisher as a possible variant of Guillain-Barré syndrome (GBS). Here, we write a case of a patient with atypical presentation of this clinical triad as the patient presented with double vision initially due to unilateral ocular involvement that progressed to bilateral ophthalmoplegia. He developed weakness of the lower extremities and areflexia subsequently. A diagnosis of MFS was made due to the clinical presentation and the presence of albuminocytologic dissociation in the cerebrospinal fluid (CSF) along with normal results of brain imaging and blood workup. The patient received intravenous immune globulin (IVIG), and his symptoms improved. The initial diagnosis of MFS is based on the clinical presentation and is confirmed by cerebral spinal fluid analysis and clinical neurophysiology studies. This case which emphasizes the knowledge of a rare syndrome can help narrow down the differentials to act promptly and appropriately manage such patients.

Miller Fisher Variant of Guillain-Barré Syndrome: A Great Masquerader

“…It is commonly thought of as a rare variant of Guillain Barre syndrome, an ascending demyelinating disease. The disease is typically found to occur after a viral illness, more commonly after a URI [2,6]. Viral prodromes have been reported in 71.8% of patients who develop MFS [6].…”

“…The disease is typically found to occur after a viral illness, more commonly after a URI [2,6]. Viral prodromes have been reported in 71.8% of patients who develop MFS [6]. Other additional symptoms that have been found to occur are paresthesia, dysesthesia, bladder dysfunction, and weakness.…”

“…In other geographic regions such as Taiwan and Japan, the incidence is up to 19% and 25%, respectively [2]. MFS presents with a clinical triad of ataxia, areflexia, and ophthalmoplegia [2,5]. One of the main differences between MFS and the other, more common variants of GBS is that the first nerve groups to demyelinate are commonly located in the cranium.…”

Síndrome Miller Fisher: un reporte de caso y diagnósticos diferenciales

“…Ahora bien, la sintomatología inicial del paciente, de un cuadro de ataxia, compuesto por adiadococinesia y no tolerancia de la bipedestación; así como la disartria y diminución de fuerza en extremidades, hacen que por anatomía se piense en la localización de una lesión o alteración en sistema nervioso central, especialmente cerebelo, corteza motora, sistema piramidal y lóbulo frontal. Al hacer este diagnóstico anatómico de lo ocurrido al paciente, teniendo en cuenta su edad, antecedentes y hallazgos sintomáticos, se puede evaluar cada una de las causas etiológicas de su cuadro clínico que abarcan lesiones neoplásicas especialmente de fosa posterior; las lesiones vasculares como un evento Cerebro vascular cerebeloso isquémico, en especial considerando el síntoma asociado de cefalea intensa en el paciente; las causas infecciosas y las causas inmunológicas (4,8). Vemos como en el paciente cada uno de los exámenes realizados fueron descartando las etiologías consideradas, así la TAC y la RNM descartaron causas neoplásicas y vasculares; en tanto que los análisis de LCR descartaron causas neuroinfecciosas.…”

Peduncular Hallucinosis and Overlapping Antiganglioside Antibody Syndrome

“…Guillain-Barré Syndrome (GBS) [1], Miller Fisher Syndrome (MFS) [2] and Bickerstaff brainstem encephalitis (BBE) [3] form part of the same disease spectrum, sharing some clinical signs and auto-immune based mechanisms with antiganglioside antibodies [4]. GBS, the most common cause of subacute flaccid paralysis, is a well-known and extensively described syndrome.…”