Recurrent Fisher’s Syndrome with Immunological Abnormalities and Replicated Laterality

Uchihara, Toshiki; Ikeda, Masayuki; Tsukagoshi, Hiroshi

doi:10.1159/000116688

Cited by 6 publications

(2 citation statements)

References 8 publications

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“…Some patients had very specific symptoms during subsequent episodes, such as unilateral cranial nerve palsy at the same site. We cannot explain this specific finding, but it could be related to a local susceptibility of neural tissue-related epitopes, as replicated laterality of cranial nerve dysfunction has been described before in MFS 15 16…”

Section: Discussionmentioning

confidence: 73%

Recurrent Guillain-Barre syndrome

Kuitwaard

Koningsveld

Ruts

et al. 2008

Journal of Neurology, Neurosurgery & Psychiatry

128

121

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Background: Guillain-Barré syndrome (GBS) is generally considered to be monophasic, but recurrences do occur in a presently undefined subgroup of patients. Objectives: To determine which subgroup of patients develops a recurrence and to establish whether preceding infections and neurological symptoms are similar in subsequent episodes. Methods: A recurrence was defined as two or more episodes that fulfilled the NINCDS criteria for GBS, with a minimum time between episodes of 2 months (when fully recovered in between) or 4 months (when only partially recovered). Patients with a treatment-related fluctuation or chronic inflammatory demyelinating polyneuropathy with acute onset were excluded. The clinical characteristics of recurrent GBS patients were compared with those of 476 non-recurrent patients. Results: 32 recurrent GBS patients, who had a total of 81 episodes, were identified. The clinical symptoms in a first episode were similar to the following episodes in individual patients, being GBS or its variant Miller Fisher syndrome (MFS) but never both. While neurological symptoms in subsequent episodes were often similar, the severity of the symptoms and the nature of the preceding infections varied. Recurrent patients (mean age 34.2 years) were younger than non-recurrent patients (mean age 46.9; p = 0.001) and more often had MFS (p = 0.049) or milder symptoms (p = 0.011). Conclusions: Genetic or immunological host factors may play an important role in recurrent GBS, since these patients can develop similar symptoms after different preceding infections. Recurrences occur more frequently in patients under 30, with milder symptoms and in MFS.

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Section: Discussionmentioning

confidence: 73%

Recurrent Guillain-Barre syndrome

Kuitwaard

Koningsveld

Ruts

et al. 2008

Journal of Neurology, Neurosurgery & Psychiatry

128

121

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“…Kundaje et al described a patient with partial right sided 3 rd and 6 th nerve palsy. 12 Another case of marked asymmetrical right sided ptosis and ophthalmoplegia was reported by Uchihara et al 13 Keichiro et al described a case of left sided near complete ophthalmoplegia with ptosis, which was interestingly associated with ataxia and areflexia limited to left side. 14 In another case series which included 34 patients, unilateral ophthalmoplegia was found in 27.3% cases.…”

Section: Discussionmentioning

confidence: 94%

An unusual case of Miller Fisher syndrome with unilateral 3rd</sup> nerve palsy and rapid recovery following intravenous immunoglobulin

Ranasinghe

Senanayake

Waidyasekara

2022

J of Cey Coll of Phy

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Miller Fisher syndrome (MFS) is an immune mediated neuropathy commonly triggered by an infection. It is considered as a variant of Guillain-Barre syndrome. Although bilateral ophthalmoplegia is the commonest ocular involvement in MFS, there are reported cases of unilateral ophthalmoplegia. MFS has a benign course and treatment is not required in majority of cases unless there is a lifethreatening complication.We report an unusual case of MFS, presented with isolated right sided oculomotor nerve palsy with pupillary involvement, ataxia and areflexia. Patient was treated with intravenous immunoglobulin (IVIG) achieving a remarkable recovery by five days of treatment. We believe this is a treatment effect rather than the natural course of her illness. Although it is rare, MFS should be included in the differential diagnosis of unilateral 3 rd nerve palsy with pupillary involvement, especially when associated with ataxia or areflexia. Having a low threshold to initiate IVIG in MFS may accelerate the recovery with a positive impact on patient's functional status.

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