Bilateral Sixth nerve palsy in a pediatric patient as first presentation of atypical miller fisher syndrome

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AbstractPurposeTo describe a case of bilateral sixth nerve palsy in the setting of an atypical Miller Fisher Syndrome (MFS), extremely rare in the pediatric population and barely documented in the literatureMethodsWe present a case of a 12‐year‐old girl who came to the emergency room for diplopia of 24 hours. She had no history of a previous infectious or febrile process, except for an episode of abdominal pain 8 days earlier. The examination revealed bilateral sixth nerve palsy. Hospital admission was decided. Two days later the clinical picture worsened, appearing swallowing difficulty, decreased strength and muscle tone in all 4 extremities. The tendon reflexes were preserved. Craniospinal MRI and lumbar puncture were normal. The electroneurogram was consistent with early stage of polyradiculoneuritis. Autoimmunity tests showed positive anti‐GT1a antibodies and negative anti‐GQ1b antibodies.ResultsBased on the findings, treatment with immunoglobulin and intravenous corticosteroids was decided. Clinical resolution was progressive and the oculomotor alteration completely remitted at 2 months.ConclusionsMFS is a rare autoimmune disease characterized by the classic triad of ophthalmoplegia, ataxia, and areflexia. It is considered a variant of Guillain‐Barré syndrome. There are few cases or series of cases described in the literature on MFS and its behavior in pediatrics. Therefore, almost all clinical and laboratory findings have been described in adults, but in pediatrics, there is still uncertainty. This can lead to difficulties in the diagnosis of MFS in these patients. MFS should always be suspected in the context of acute diplopia or oculomotor paralysis in pediatrics, especially if it is bilateral; despite that its bilateral character seems to be less than in adults. Fortunately, even in these patients, it maintains its self‐limited behavior, so a full recovery is expected.Mane S, (2020) Miller Fisher in a Child. Journal of Pediatric Neurosciences.