Ravlic MM, Knezevic L, Krolo I, Herman JS. Ocular Manifestations of Miller Fisher Syndrome: a Case Report.
Med Arch 2021;
75:234-236. [PMID:
34483456 PMCID:
PMC8385741 DOI:
10.5455/medarh.2021.75.234-236]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background:
Miller Fisher syndrome (MFS) is a variant of Guillain-Barré syndrome and is characterised by a clinical triad of ophthalmoplegia, ataxia and areflexia.
Objectives:
This report presents an atypical case of MFS characterized by ocular and gastrointestinal involvement, and anti-ganglioside antibody-positivity.
Methods:
A 17-year old boy was referred to our ophthalmology emergency room with signs and symptoms of diplopia and upper lid ptosis of the right eye. He underwent a complete ophthalmologic examination with special reference to strabologic status, as well as a neuropediatric examination with serum antiganglioside antibody panel.
Results:
Strabologic examination showed horisontal diplopia (near and far), ptosis of the upper eyelid on the right and bilateral ophthalmoplegia (limited elevation). Orthoptic examination revealed esotropia of 8 prism dioptres (PD) at near and 18 PD at far distance. A pediatric neurologist found normal limb power, deep tendon reflexes and flexor plantar responses, but attenuated right patellar reflex. Serum anti-GQ1b IgG (+++), anti-GQ1b IgM (++) and anti-GD1a IgM(++) were positive. Positivity of anti-GQ1b IgG antibody confirmed the existence of incomplete MFS. We treated the patient with systemic intravenous immunoglobulins for five days, and after five months of follow-up, all symptoms resolved.
Conclusion:
MFS can present itself as a wide range of clinical features and its timely recognition is important. Despite the alarming nature of the disease, patients with MFS tend to have a good recovery of presented symptoms, and without any significant residual deficit.
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