Abstract
Miller Fisher syndrome (MFS) is a rare acquired neuropathy resulting from an acute infection and is believed to be a variant of Guillain-Barre syndrome (GBS). Its characteristic features are triads of ataxia, areflexia and ophthalmolegia, though involvement of cranial nerves is possible. Our case report describes a middle-aged man who presented as a potential stroke patient with left-sided facial droop, dysphagia and weakness. Upon in-depth clinical examination and basic investigations, stroke was deemed unlikely and clinical diagnosis of MFS was reached. This was further confirmed by the presence of anti-GQ1b antibody and anti-GT1a antibody in the serological study. Our patient was closely monitored with spirometry checks and only received supportive therapy throughout his treatment course until he achieved full clinical recovery. From this case we learnt that the clinical manifestations of MFS may vary depending on the presence of different types of autoantibodies. Similar to GBS, management of MFS is also largely supportive. Despite the widespread use of intravenous immunoglobulins with or without plasmapheresis to treat MFS, there is no conclusive evidence yet regarding prioritizing one treatment over another as the disease itself is self-limiting.
Highlights
Miller Fisher syndrome (MFS) is a rare acquired neuropathy resulting from an acute infection and is believed to be a variant of Guillain-Barre syndrome (GBS)
Miller Fisher syndrome (MFS) is a rare acquired polyneuropathy precipitated by an acute infection, more commonly respiratory than gastrointestinal (GI) or meningeal source, and it is recognized as a variant of Guillain-Barre' syndrome (GBS) [1]
MFS is characterized by areflexia, ataxia and ophthalmoplegia without significant sensory loss [4]
Summary
Miller Fisher syndrome (MFS) is a rare acquired polyneuropathy precipitated by an acute infection, more commonly respiratory than gastrointestinal (GI) or meningeal source, and it is recognized as a variant of Guillain-Barre' syndrome (GBS) [1]. We describe a case of a man presenting initially as a ‘stroke alert’ patient to the local emergency department who was later diagnosed with MFS after thorough clinical judgement He received only supportive care including nasogastric tube feeding throughout his admission. We report a 65-year-old man who was brought into the emergency department at an early hour as a potential subacute stroke patient He presented with left facial droop, slurring of speech and gait instability, resulting in collapse at home. In view of the complex set of presenting symptoms a few weeks apart from each other and normal CT, he was deemed unlikely to be suffering from a subacute stroke, and stroke treatment was not given He was thought to have Bell’s palsy as a part of the diagnoses. Laboratory investigations Full blood count (FBC) White cell count (WCC) Platelets Sodium (Na) Potassium (K) Adjusted calcium Magnesium
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