Clinical Features of Miller-Fisher Syndrome in Pregnancy

Abstract

Miller-Fisher syndrome (MFS) is recognized as a variant of Guillain-Barré syndrome (GBS). MFS is a rare disorder that is characterized by the acute onset of ophthalmoplegia, ataxia, and areflexia/hyporeflexia. MFS has a higher incidence in Asia, where the incidence is estimated to be 18%–26% of GBS compared with 3%–5% in the West. The differential diagnosis of MFS includes Wernicke's encephalopathy (WE) which is characterized by a clinical triad (nystagmus and ophthalmoplegia, mental status changes, and ataxia), myasthenia gravis, and brainstem stroke. The association between MFS and pregnancy has not been reported previously. Here, we describe the clinical features of a pregnant woman in early pregnancy with MFS. This case highlights the fact that it is necessary to establish an accurate diagnosis based on the details from the patient's history on appropriate complementary testing in a pregnant patient with MFS.

Dimensions of SARS-CoV-2 associated Guillain-Barré syndrome

“…Ptosis is an uncommon manifestation of most GBS subtypes, except in MFS where it occurs in about 10% of the cases (Oono et al, 2015). Thus, we should be told whether the 2 patients of the present study who presented with ptosis were among those 11 patients with MFS.…”

Clinical Reasoning: Acute onset of diplopia in pregnancy

“…One case report presents a case of MFS masquerading as Wernicke syndrome, where once the diagnosis of MFS was established, the patient was treated conservatively. 9 MFS is often a self-limiting condition with a good outcome. The condition begins to subside from 1 to 3 months following onset, with almost complete resolution of symptoms within 6 months.…”

The case of Miller-Fisher syndrome in pregnancy

“…СГБ чаще раз-вивается во второй половине беременности: на первый триместр приходится 13 % случаев, на второй -40 %, на третий 47 % случаев [6]. Описаны случаи развития СГБ на фоне токсикоза первой половины беременности с цитолитическим синдром [10]. Однако данных, чтобы рассматривать эту патологию беременности фактором риска развития СГБ или других воспалительных полиневропатий, недостаточно.…”