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Yasin AL, Rychwalski PJ, Khodeiry MM, Fouzdar Jain S. Bilateral Enhancement of Oculomotor Nerves: A Sign of Miller Fisher Syndrome. J Neuroophthalmol 2023:00041327-990000000-00497. [PMID: 37938043 DOI: 10.1097/wno.0000000000002043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Affiliation(s)
- Anas L Yasin
- Department of Ophthalmology (ALY, PJR, SFJ), University of Nebraska Medical Center, Omaha, Nebraska; Children's Hospital & Medical Center (ALY, PJR, SFJ), Omaha, Nebraska; and UPMC Children's Hospital of Pittsburgh (MMK), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Hakobyan N, Yadav R, Pokhrel A, Wasifuddin M, John MJ, Yadav S, Boris A. Miller-Fisher Syndrome Unveiled in the Presence of Cholangiocarcinoma. Cureus 2023; 15:e49016. [PMID: 38111454 PMCID: PMC10727167 DOI: 10.7759/cureus.49016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Miller-Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome, characterized by ataxia, areflexia, ophthalmoplegia, and possible facial, swallowing and limb weakness alongside respiratory failure. Variations within MFS may include respiratory and limb weakness and Bickerstaff brainstem encephalitis (BBE), marked by altered consciousness, ataxia, ophthalmoparesis, and paradoxical hyperreflexia. MFS can emerge in both children and adults, often following bacterial or viral illness. While autoimmune-driven nerve damage occurs, most MFS patients recover within six months without specific treatment, with a low risk of lasting neurological deficits or relapses. Rarely fatal, MFS's co-occurrence with cholangiocarcinoma (CCA) presents unique management challenges. CCA, primarily affecting bile ducts, has a bleak prognosis; surgical resection offers limited cure potential due to late-stage detection and high recurrence rates. Advances in CCA's molecular understanding have led to novel diagnostic and therapeutic approaches, requiring a comprehensive interdisciplinary care approach for optimal MFS and CCA management outcomes. Herein, we present a 50-year-old male with a complex medical history who was admitted to the hospital due to abdominal discomfort, nausea, vomiting, and ascites. Imaging revealed pneumonia and secondary bacterial peritonitis. Later, he developed neurological symptoms, including weakness, gait abnormalities, and brainstem symptoms, leading to the diagnosis of MFS. Despite treatment efforts, his condition deteriorated, leading to acute liver failure and unexplained anasarca. N-acetyl cysteine was initiated for liver issues. Neurologically, he showed quadriparesis and areflexia. Intravenous immunoglobulin (IVIG) treatment improved his neurological symptoms but worsened gastrointestinal issues, including ileus and elevated CA19-9 levels, suggesting a potential carcinoma. A liver biopsy was performed. After IVIG treatment, he experienced widespread discomfort, emotional unresponsiveness, swallowing difficulties, and aspiration risk, ultimately leading to his demise.
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Affiliation(s)
- Narek Hakobyan
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Ruchi Yadav
- Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Akriti Pokhrel
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Mustafa Wasifuddin
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Michaela J John
- Internal Medicine, St. George's University School of Medicine, Brooklyn, USA
| | - Siddharth Yadav
- School of Health Sciences, The Bronx High School of Science, Bronx, USA
| | - Avezbakiyev Boris
- Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
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Alijanzadeh D, Soltani A, Afra F, Salmanpour F, Loghman AH, Samieefar N, Rezaei N. Clinical characteristics and prognosis of temporary miller fisher syndrome following COVID-19 vaccination: a systematic review of case studies. BMC Neurol 2023; 23:332. [PMID: 37735648 PMCID: PMC10512542 DOI: 10.1186/s12883-023-03375-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Miller Fisher syndrome (MFS) is a subtype of Guillain-Barré syndrome (GBS) which is characterized by the three components of ophthalmoplegia, ataxia, and areflexia. Some studies reported MFS as an adverse effect of the COVID-19 vaccination. We aimed to have a detailed evaluation on demographic, clinical, and para-clinical characteristics of subjects with MFS after receiving COVID-19 vaccines. MATERIALS AND METHODS A thorough search strategy was designed, and PubMed, Web of Science, and Embase were searched to find relevant articles. Each screening step was done by twice, and in case of disagreement, another author was consulted. Data on different characteristics of the patients and types of the vaccines were extracted. The risk of bias of the studies was assessed using Joanna Briggs Institute (JBI) tools. RESULTS In this study, 15 patients were identified from 15 case studies. The median age of the patients was 64, ranging from 24 to 84 years. Ten patients (66.6%) were men and Pfizer made up 46.7% of the injected vaccines. The median time from vaccination to symptoms onset was 14 days and varied from 7 to 35 days. Furthermore,14 patients had ocular signs, and 78.3% (11/14) of ocular manifestations were bilateral. Among neurological conditions, other than MFS triad, facial weakness or facial nerve palsy was the most frequently reported side effect that was in seven (46.7%) subjects. Intravenous immunoglobulin (IVIg) was the most frequently used treatment (13/15, 86.7%). Six patients received 0.4 g/kg and the four had 2 g/kg. Patients stayed at the hospital from five to 51 days. No fatal outcomes were reported. Finally, 40.0% (4/15) of patients completely recovered, and the rest experienced improvement. CONCLUSION MFS after COVID-19 immunization has favorable outcomes and good prognosis. However, long interval from disease presentation to treatment in some studies indicates that more attention should be paid to MFS as the adverse effect of the vaccination. Due to the challenging diagnosis, MFS must be considered in list of the differential diagnosis in patients with a history of recent COVID-19 vaccination and any of the ocular complaints, ataxia, or loss of reflexes, specially for male patients in their 60s and 70s.
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Affiliation(s)
- Dorsa Alijanzadeh
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Soltani
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Afra
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Fardis Salmanpour
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Hossein Loghman
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Noosha Samieefar
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Research Center for Immunodeficiencies, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Zhang L, Ma L, Zhou L, Sun L, Han C, Fang Q. Miller-Fisher syndrome with positive anti-GD1b and anti-GM1 antibodies combined with multiple autoimmune antibodies: A case report. Medicine (Baltimore) 2023; 102:e34969. [PMID: 37653808 PMCID: PMC10470702 DOI: 10.1097/md.0000000000034969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
RATIONALE Anti-ganglioside antibodies (AGA) play an essential role in the development of Miller-Fisher syndrome (MFS). The positive rate of ganglioside antibodies was exceptionally high in MFS, especially anti-GQ1b antibodies. However, the presence of other ganglioside antibodies does not exclude MFS. PATIENT CONCERNS We present a 48-year-old male patient who suddenly developed dizziness, visual rotation, nausea, and vomiting accompanied by unsteady gait and diplopia for 3 days before presentation to our clinic. DIAGNOSES On physical examination, the patient's right eye could not fully move to the right side and horizontal nystagmus was found. Coordination was also impaired in the upper and lower extremities with dysmetria and dysdiadochokinesia. The electromyography and cerebrospinal fluid examination results were normal. The serum anti-GQlb antibody test results were negative. However, serum anti-GD1b IgM and anti-GM1 IgM antibodies were positive. Meanwhile, the anti-thyroid peroxidase antibody was >600.00 IU/mL (0.00-34.00), and the anti-SS-A/Ro52 antibody was positive. He was diagnosed with MFS. INTERVENTIONS The patient received IVIg treatment for 5 days (0.4 g/kg/day) from day 2 to day 6 of hospitalization. On the 7th day of admission, the patient was administered intravenous methylprednisolone (500 mg/day), which was gradually reduced. OUTCOMES The patient's symptoms improved after treatment with immunoglobulins and hormones. LESSONS We report a case of MFS with positive anti-GD1b and anti-GM1 antibodies combined with multiple autoimmune antibodies. Positive ganglioside antibodies may be used as supporting evidence for the diagnosis; however, the diagnosis of MFS is more dependent on clinical symptoms.
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Affiliation(s)
- Limei Zhang
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Linqing Ma
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Lihua Zhou
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Lu Sun
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Chunru Han
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Qi Fang
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Poyraz T. Miller Fisher Syndrome Associated With COVID-19: A History of Molecular Mimicry and an Up-to-Date Review of the Literature. Cureus 2023; 15:e43111. [PMID: 37692684 PMCID: PMC10484161 DOI: 10.7759/cureus.43111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Miller Fisher syndrome (MFS) was first recognized by Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. In 1956, three cases with this triad were published by Miller Fisher as a limited variant of Guillian-Barré syndrome (GBS), and the disease started to be called by his name. Since the beginning of the SARS-CoV-2 pandemic, there have been many reports of peripheral and central nervous system involvement. Until December 2022, a total of 24 cases, including four children associated with MFS, had been reported. This current review aimed to present the basic clinical and laboratory characteristics of patients with MFS and coronavirus disease-2019 (COVID-19). Since 2020, cases with different age and gender characteristics have been reported from eight different countries. Most cases were reported from Europe. SARS-CoV-2 infection was confirmed in seven of the cases. The youngest case reported was a 6-year-old boy from Turkey, while the oldest case was a 70-year-old female from Spain. All these reported cases and our past medical knowledge of MFS suggest that molecular mimicry is the main immunological mechanism. Despite all these data, more case reports, cohorts, and case-control studies will be needed to clarify the relationship between MFS and COVID-19.
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Affiliation(s)
- Turan Poyraz
- Department of Elderly Care, Izmir University of Economics, İzmir, TUR
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Poyraz T. Miller Fisher Syndrome Associated With COVID-19: A Child Case Report and an Up-to-Date Review of the Literature. Cureus 2023; 15:e35656. [PMID: 37009389 PMCID: PMC10065806 DOI: 10.7759/cureus.35656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Miller Fisher Syndrome (MFS) was first recognized by James Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. In 1956, three cases with this triad were published by Charles Miller Fisher as a limited variant of Guillian-Barré syndrome (GBS), and the disease started to be called by his name. Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there have been many reports of peripheral and central nervous system involvement. Until December 2022, a total of 23 cases including two children associated with MFS had been reported. In this article, we present a case of SARS-CoV-2 with classic triad clinical findings, which started with the atypical clinic at an early age. Electrophysiological studies of the case were found to be consistent with sensory axonal polyneuropathy. AntiGQ1b antibody IgG and IgM were negative. The case was spontaneously remitted without IV immunoglobulin (IVIg) or plasma exchange (PE) treatment. A current review of the literature is presented with the smallest pediatric case reported. Based on this case, it was planned to emphasize the targets and highlights in the diagnostic parameters.
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Abu-Abaa M, Jumaah O, Mousa A, Aldookhi A. Miller Fisher Syndrome With Positive Anti-GQ1b/GQ1d Antibodies Associated With COVID-19 Infection: A Case Report. Cureus 2023; 15:e36924. [PMID: 37128531 PMCID: PMC10148731 DOI: 10.7759/cureus.36924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/03/2023] Open
Abstract
The association between Guillain-Barré Syndrome (GBS) and its variants including Miller Fisher syndrome (MFS) has been reported and debated in the literature. Herein, we are reporting a 59-year-old male patient who had flu-like symptoms for 10 days prior to presentation with rapidly progressive weakness, dysphagia, and dysarthria. He tested positive for COVID-19 and further workup showed positive anti-GQ1b and GQ1d antibodies. The diagnosis of MFS was presumed and prompted the commencement of intravenous immunoglobulin (IVIG). Respiratory deterioration prompted intubation and failure of extubation necessitated plasmapheresis. This treatment culminated in successful extubation and discharge to a long-term care facility. This case adds to the currently limited body of cases that report the association of a rare GBS variant with COVID-19 infection. Only a few of the reported cases of COVID-19-related MFS cases had positive anti-GQ1b antibodies. This may well be the first reported case of COVID-19-related MFS with positive anti-GQ1b and anti-GQ1d antibodies.
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Affiliation(s)
- Mohammad Abu-Abaa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Omar Jumaah
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Aliaa Mousa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Alaa Aldookhi
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
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Ooi ST, Ahmad A, Yaakub A. Recurrent Miller Fisher Syndrome. Cureus 2022; 14:e26192. [PMID: 35891880 PMCID: PMC9306407 DOI: 10.7759/cureus.26192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/20/2022] Open
Abstract
Miller Fisher syndrome (MFS) is an uncommon systemic autoimmune condition. Recurrent Miller Fisher syndrome is extremely rare. We want to highlight a rare case of recurrent Miller Fisher syndrome, which manifested as external and internal ophthalmoplegia, areflexia, and ataxia following an episode of upper respiratory tract infection (URTI). The patient developed a recurrent attack of Miller Fisher syndrome two months later with only internal and external ophthalmoplegia symptoms. Both episodes wholly resolved in a month without treatment. Miller Fisher syndrome can mimic various other neurological illnesses. Therefore, diagnosing this disease is often challenging. However, prompt diagnosis and management can be achieved with awareness of this rare illness.
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Ghani MR, Yousaf MIK, Van Bussum K, Shi P, Cordoves Feria RM, Brown M. Miller Fisher Syndrome Presenting Without Areflexia, Ophthalmoplegia, and Albuminocytological Dissociation: A Case Report. Cureus 2022; 14:e23371. [PMID: 35475055 PMCID: PMC9018960 DOI: 10.7759/cureus.23371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS) with a prevalence of one to two people per million each year. Viral and/or bacterial infection often precedes the classic triad of areflexia, ophthalmoplegia, and ataxia. Bulbar involvement is uncommon but can lead to extensive workup to rule out stroke, myasthenia gravis (MG), and other neuromuscular disorders. We present a case of a 32-year-old healthy male with a past medical history of Lyme disease as a teenager and sore throat two weeks prior. He presented to the hospital with rapidly ascending paresthesias in bilateral upper and lower extremities, urinary incontinence, and mild slurred speech. Exam on presentation revealed mild dysmetria in bilateral upper and lower limbs. The remainder of the exam was negative. Neuroradiological imaging, including magnetic resonance imaging (MRI) with and without contrast of the brain and the cervical and lumbar spine, did not show any acute process or abnormal enhancement. Lumbar puncture revealed cerebrospinal fluid (CSF) with normal protein and cell count, and hence no albuminocytological dissociation (ACD). Immunoserology was positive for Epstein-Barr virus (EBV) immunoglobulin G (IgG) but negative for immunoglobulin M (IgM). Despite the absent ACD, areflexia, and no third, fourth, and sixth cranial nerve deficits, there was high suspicion for GBS due to acutely rapid ascending paresthesia, mild dysarthria, and mild ataxia. The patient was started on intravenous immunoglobulin (IVIG) 2 mg/kg divided into five days within 24 hours of admission. The patient developed areflexia in all limbs on the second day of admission and complained of double vision. On the third day of admission, the patient's negative respiratory force (NIF) declined to −23, and he was intubated for airway protection. Our patient completed five days of IVIG. Positive anti-GQ1b antibodies further supported the diagnosis of MFS. After a seven-day ICU stay and 20 days of aggressive inpatient rehabilitation, the patient could do most of the activities of daily living independently. After six weeks, he was back to his normal baseline and restarted his job.
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Korona A, Maritsi D, Markante A, Stamati A, Mouskou S, Vartzelis G. Eyes wide open—an atypical presentation of Miller Fisher syndrome (MFS): case report. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00451-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Parinaud’s syndrome, also known as dorsal midbrain syndrome, is characterized by a combination of signs, including upgaze palsy, convergence–retraction nystagmus, eyelid retraction and pupillary dissociation. It is caused by pretectal or tegmental lesions of upper brainstem. Miller Fisher syndrome, characterized by the triad of ataxia, areflexia and ophthalmoplegia, has rarely been reported to present as Parinaud’s syndrome in adults. To our knowledge, this clinical manifestation has not been previously described in children.
Case presentation
A previously healthy 13-year-old girl presented with blurred vision and diplopia, 10 days after a viral infection. Initial examination revealed incomplete Parinaud’s syndrome, while rest of neurological examination was normal. Brain imaging (MRI, MRA) did not reveal any abnormal findings and CSF findings were also normal. During the first days after admission she gradually deteriorated, showing complete external ophthalmoplegia, unsteady gait, and absent deep tendon reflexes of lower limbs with normal muscle power. With the clinical suspicion of Miller Fisher syndrome IVIG was administered, leading to subsequent resolution of her symptoms. AntiGQ1b and antiGD1b antibodies came back positive confirming diagnosis. On 1 month follow-up, neurological examination revealed diplopia in left gaze, and a second dose of IVIG was administered with good response. She remains asymptomatic 1 year from disease onset.
Conclusions
Miller Fisher syndrome can rarely present as Parinaud’s syndrome in adults. Herein we described the first pediatric patient with similar clinical presentation. As the typical semiology of ataxia and areflexia may not be present initially, high index of suspicion is required to recognise and treat those patients promptly. Serological detection of anti-ganglioside antibodies, such as anti-GQ1b and anti-GD1b, may help confirm diagnosis.
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Faulkner DL, Scott DS, Flint DNJ. Miller-Fisher syndrome associated with SARS-CoV-2: a case report. Microbes Infect 2022; 24:104954. [PMID: 35240290 PMCID: PMC8882477 DOI: 10.1016/j.micinf.2022.104954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/28/2022]
Abstract
SARS-CoV-2 infections are increasingly associated with neurological complications, including immune-mediated neuropathies. Miller–Fisher syndrome is a rare variant of Guillain-Barré syndrome characterised by the triad of ataxia, ophthalmoplegia and areflexia. Here we present a case of Miller–Fisher syndrome following COVID-19 infection. The clinical presentation was a short history of a rapidly-progressive peripheral sensorimotor neuropathy with bulbar dysfunction and facial weakness following mild COVID infection. Examination revealed global areflexia and a broad-based ataxic gait. CSF analysis revealed albuminocytological dissociation and neurophysiological testing later supported the diagnosis. The patient required high flow nasal oxygen therapy for respiratory dysfunction in a level 2 care setting and received immunological treatment with intravenous immunoglobulins. We conclude that Miller–Fisher syndrome needs to be considered in patients presenting with new sensorimotor dysfunction following SARS-COV-2 infection. Early recognition is key given the propensity to cause life-threatening respiratory failure, and early administration of immunological treatment is associated with improved prognosis.
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El-Abassi RN, Soliman M, Levy MH, England JD. Treatment and Management of Autoimmune Neuropathies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Landeiro L, Oliveira R, Graça J, Gouveia R. Traditional Neurosyphilis in 21st Century - Tabes Dorsalis, Dementia Paralytica, Aseptic Meningitis and Unilateral Oculomotor Nerve Palsy in an HIV-Negative Man. Cureus 2021; 13:e18869. [PMID: 34804719 PMCID: PMC8597670 DOI: 10.7759/cureus.18869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/05/2022] Open
Abstract
Syphilis is potentially a multisystem chronic infection caused by Treponema pallidum. Late symptomatic neurosyphilis has been less reported in developed countries, most often seen in untreated patients or in patients with HIV coinfection. We present a case of complicated neurosyphilis with widespread neurological involvement (dementia paralytica, tabes dorsalis, leptomeningitis and left oculomotor nerve involvement) presenting in the 21st century in an urban area of a well-developed European country in an HIV-negative patient.
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Affiliation(s)
- Luis Landeiro
- Internal Medicine, Hospital da Luz Lisboa, Lisboa, PRT
| | | | - Joana Graça
- Neuroradiology, Hospital da Luz Lisboa, Lisboa, PRT
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Glover K, Mishra D, Singh TRR. Epidemiology of Ocular Manifestations in Autoimmune Disease. Front Immunol 2021; 12:744396. [PMID: 34795665 PMCID: PMC8593335 DOI: 10.3389/fimmu.2021.744396] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 01/19/2023] Open
Abstract
The global prevalence of autoimmune diseases is increasing. As a result, ocular complications, ranging from minor symptoms to sight-threatening scenarios, associated with autoimmune diseases have also risen. These ocular manifestations can result from the disease itself or treatments used to combat the primary autoimmune disease. This review provides detailed insights into the epidemiological factors affecting the increasing prevalence of ocular complications associated with several autoimmune disorders.
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Affiliation(s)
| | | | - Thakur Raghu Raj Singh
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, Belfast, United Kingdom
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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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Affiliation(s)
- Maja Malenica Ravlic
- Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Lana Knezevic
- Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Iva Krolo
- Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Jelena Skunca Herman
- Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
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High-resolution MR imaging of cranial neuropathy in patients with anti-GQ1b antibody syndrome. J Neurol Sci 2021; 423:117380. [PMID: 33677393 DOI: 10.1016/j.jns.2021.117380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/27/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The value of conventional MRI in patients anti-GQ1b antibody syndrome is subject to debate. Our purpose was to evaluate the diagnostic accuracy of high-resolution MRI for detecting cranial nerve abnormalities in patients with anti-GQ1b antibody syndrome. MATERIALS AND METHODS This retrospective cohort study enrolled 15 anti-GQ1b-positive patients diagnosed with MFS and related disorders and 17 age-matched controls, all of whom underwent high-resolution MR imaging including pre-contrast and contrast-enhanced (CE) 3D FLAIR and 3D CE T1-weighted turbo field echo (T1-TFE) between 2010 and 2016. The diagnostic performance of high-resolution MRI was assessed using the area under the curve (AUC) of the receiver operating characteristics curve. Inter- and intraobserver agreements were calculated using kappa statistics and intraclass correlation coefficients (ICC), respectively. RESULTS Ophthalmoplegia, ataxia, and hypo/areflexia were present in 100%, 60%, and 67%, respectively. Other neurologic findings included ptosis (40%), mydriasis (13%), and facial (27%) and bulbar (13%) palsy. Fourteen of sixteen (88%) MR examinations in 15 patients demonstrated at least one cranial nerve abnormality corresponding to the clinical findings. The involved cranial nerves on MRI were the IIIrd cranial nerve in 14 patients, VIth in nine, VIIth in four, Vth in one, and VIIIth in one. AUC values for detecting cranial neuropathy on high-resolution MRI were 0.938 (95% CI: 0.795-0.992) on a per patient basis. Inter- and intraobserver agreements were 0.842 and 0.945, respectively. CONCLUSION High-resolution 3D FLAIR and CE 3D T1-TFE MRI has high reliability and accuracy for demonstrating cranial neuropathy in patients with anti-GQ1b antibody syndrome.
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Atypical Variant of Guillain Barre Syndrome in a Patient with COVID-19. ACTA ACUST UNITED AC 2020; 6:231-236. [PMID: 33200094 PMCID: PMC7648437 DOI: 10.2478/jccm-2020-0038] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/20/2020] [Indexed: 12/30/2022]
Abstract
Objective A rare variant Miller Fisher Syndrome overlap with Guillain Barre Syndrome is described in an adult patient with SARS-COV-2 infection. Case Presentation The clinical course of a 45-year-old immunosuppressed man is summarized as a patient who developed ataxia, ophthalmoplegia, and areflexia after upper respiratory infection symptoms began. A nasopharyngeal swab was positive for COVID-19 polymerase chain reaction. He progressed to acute hypoxemic and hypercapnic respiratory failure requiring intubation and rapidly developed tetraparesis. Magnetic resonance imaging of the spine was consistent with Guillain Barre Syndrome. However, the clinical symptoms, along with positive anti-GQ1B antibodies, were consistent with Miller Fisher Syndrome and Guillain Barre Syndrome overlap. The patient required tracheostomy and had limited improvement in his significant neurological symptoms after several months. Conclusions The case demonstrates the severe neurological implications, prolonged recovery and implications in the concomitant respiratory failure of COVID-19 patients with neurological symptoms on the spectrum of disorders of Guillain Barre Syndrome.
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Urlapu KS, Saad M, Bhandari P, Micho J, Hassan MT. Miller Fisher Variant of Guillain-Barré Syndrome: A Great Masquerader. Cureus 2020; 12:e11045. [PMID: 33224642 PMCID: PMC7676442 DOI: 10.7759/cureus.11045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Guillain-Barré Syndrome (GBS) is an acquired degenerative, demyelinating neurological disorder classically characterized by progressive, symmetrical ascending paralysis. Often associated to occur after a viral illness, most commonly an upper respiratory infection (URI), followed by gastrointestinal illnesses. Here we present a case of Miller Fisher syndrome (MFS) which is a rare variant of GBS. MFS presents with a triad of ataxia, areflexia, and opthalmoplegia. MFS is a clinical diagnosis but can be confirmed serologically with positive anti-ganglioside antibodies.
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Lantos JE, Strauss SB, Lin E. COVID-19-Associated Miller Fisher Syndrome: MRI Findings. AJNR Am J Neuroradiol 2020; 41:1184-1186. [PMID: 32467190 DOI: 10.3174/ajnr.a6609] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/02/2020] [Indexed: 11/07/2022]
Abstract
Miller Fisher syndrome, also known as Miller Fisher variant of Guillain-Barré syndrome, is an acute peripheral neuropathy that can develop after exposure to various viral, bacterial, and fungal pathogens. It is characterized by a triad of ophthalmoplegia, ataxia, and areflexia. Miller Fisher syndrome has recently been described in the clinical setting of the novel coronavirus disease 2019 (COVID-19) without accompanying imaging. In this case, we report the first presumptive case of COVID-19-associated Miller Fisher syndrome with MR imaging findings.
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Affiliation(s)
- J E Lantos
- From the Department of Radiology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York.
| | - S B Strauss
- From the Department of Radiology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York
| | - E Lin
- From the Department of Radiology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, New York
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20
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Patel K, Nussbaum E, Sico J, Merchant N. Atypical case of Miller-Fisher syndrome presenting with severe dysphagia and weight loss. BMJ Case Rep 2020; 13:13/5/e234316. [PMID: 32467120 DOI: 10.1136/bcr-2020-234316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 71-year-old man developed dysphagia, bilateral lower extremity muscle weakness and weight loss. He was admitted to the hospital after a failed formal swallow evaluation, nearly 3 weeks after symptom onset. In addition to dysphagia and weakness, physical examination was notable for hypophonia, dysarthria, diplopia, horizontal ophthalmoparesis, ptosis, ataxia and hyporeflexia. Cerebrospinal fluid was notable for albuminocytological dissociation and serum anti-GQ1b antibody titre was elevated (1:200). A diagnosis of Miller-Fisher syndrome (MFS) was made, and the patient was treated with intravenous immunoglobulin (0.4 g/kg/day) for 5 days, which resulted in resolution of symptoms. This is an atypical case of MFS, in that the presenting symptom was progressive dysphagia rather than the ophthalmoplegia and ataxia that are normally seen in MFS. Patients who present with dysphagia should receive a thorough neurological examination, with particular attention to extraocular movements, reflexes and gait stability, to rule out MFS as a potential cause.
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Affiliation(s)
- Kishan Patel
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Eliezer Nussbaum
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason Sico
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Neurology, VA Connecticut Health System, West Haven, Connecticut, USA
| | - Naseema Merchant
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA .,Internal Medicine, VA Connecticut Health System, West Haven, Connecticut, USA
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21
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Ryu WY, Kim YH, Yoon BA, Park HT, Bae JS, Kim JK. Pattern of Extraocular Muscle Involvements in Miller Fisher Syndrome. J Clin Neurol 2019; 15:308-312. [PMID: 31286701 PMCID: PMC6620438 DOI: 10.3988/jcn.2019.15.3.308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The most-common initial manifestation of Miller Fisher syndrome (MFS) is diplopia due to acute ophthalmoplegia. However, few studies have focused on ocular motility findings in MFS. This study aimed to determine the pattern of extraocular muscle (EOM) paresis in MFS patients. Methods We consecutively recruited MFS patients who presented with ophthalmoplegia between 2010 and 2015. The involved EOMs and the strabismus pattern in the primary position were analyzed. Antecedent infections, other involved cranial nerves, and laboratory findings were also reviewed. We compared the characteristics of the patients according to the severity of ophthalmoplegia between complete ophthalmoplegia (CO) and incomplete ophthalmoplegia (IO). Results Twenty-five patients (15 males and 10 females) with bilateral ophthalmoplegia were included in the study. The most-involved and last-to-recover EOM was the lateral rectus muscle. CO and IO were observed in 11 and 14 patients, respectively. The patients were aged 59.0±18.4 years (mean±SD) in the CO group and 24.9±7.4 years in the IO group (p<0.01), and comprised 63.6% and 21.4% females, respectively (p=0.049). Elevated cerebrospinal fluid protein was identified in 60.0% of patients with CO and 7.7% of patients with IO (p=0.019) for a mean follow-up time from the initial symptom onset of 3.7 days. Conclusions The lateral rectus muscle is the most-involved and last-to-recover EOM in ophthalmoplegia. The CO patients were much older and were more likely to be female and have an elevation of cerebrospinal fluid protein than the IO patients.
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Affiliation(s)
- Won Yeol Ryu
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Yoo Hwan Kim
- Department of Neurology, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Byeol A Yoon
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea.,Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Korea
| | - Hwan Tae Park
- Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Korea.,Department of Molecular Neuroscience, Dong-A University College of Medicine, Busan, Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea.,Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Korea.
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22
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Abstract
The spine is frequently involved in systemic diseases, including those with neuropathic, infectious, inflammatory, rheumatologic, metabolic, and neoplastic etiologies. This article provides an overview of systemic disorders that may affect the spine, which can be subdivided into disorders predominantly involving the musculoskeletal system (including bones, joints, disks, muscles, and tendons) versus those predominantly involving the nervous system. By identifying the predominant pattern of spine involvement, a succinct, appropriate differential diagnosis can be generated. The importance of reviewing the medical record, as well as prior medical imaging (including nonspine imaging), which may confer greater specificity to the differential diagnosis, is stressed.
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Affiliation(s)
- Sean C Dodson
- Radiology Specialists of Florida, 2600 Westhall Lane, Maitland, FL 32751, USA
| | - Nicholas A Koontz
- Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202-3082, USA.
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23
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Choi KD, Choi SY, Choi JH, Kim SH, Lee SH, Jeong SH, Kim HJ, Choi JY, Kim JS. Characteristics of single ocular motor nerve palsy associated with anti-GQ1b antibody. J Neurol 2018; 266:476-479. [PMID: 30556099 DOI: 10.1007/s00415-018-9161-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022]
Abstract
To define the prevalence and characteristics of single ocular motor nerve palsy (OMNP) associated with positive serum anti-GQ1b antibody. We performed a prospective multicenter study that recruited 82 patients with single OMNP without identifiable causes from the history and neuroimaging in six neurology clinics of university hospitals. We measured serum anti-GQ1b antibody in all participants. Twelve patients with multiple OMNP and 30 with identifiable causes served as the controls. Overall, the prevalence of anti-GQ1b antibody syndrome was 10% (8/82) in patients with single OMNP and 6% (5/78) in those with single OMNP in isolation. None of the 14 patients with OMNP with identifiable causes showed positive serum anti-GQ1b antibody. The prevalence of anti-GQ1b antibody syndrome was much higher in patients with multiple OMNP than in those with single OMNP (50% vs. 10%, p < 0.01). Patients with single OMNP and positive anti-GQ1b antibody are younger (42 ± 16 vs. 58 ± 15, p < 0.05) and had a significantly higher frequency of preceding infection (75 vs. 19%, p < 0.05) and other neurological signs (38 vs. 1%, p < 0.05) than those with negative antibody. Eight patients with single OMNP and positive serum anti-GQ1b antibody involved the abducens (n = 6), trochlear (n = 1), or oculomotor nerve (n = 1). Single OMNP accompanying other neurological signs and multiple OMNP are more likely to be associated with anti-GQ1b antibody. Anti-GQ1b antibody syndrome should be considered even in patients with single OMNP, especially when antecedent infection was associated in younger patients.
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Affiliation(s)
- Kwang-Dong Choi
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Seo Young Choi
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Jae-Hwan Choi
- Department of Neurology, Biomedical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Seong Hi Kim
- Department of Neurology, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Seong-Han Lee
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Seong-Hae Jeong
- Department of Neurology, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyo-Jung Kim
- Department of Neurology, Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea
| | - Ji-Soo Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea.
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea.
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24
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Han J, Ji Y, Cao D, Kang Z, Zhu J. Miller Fisher syndrome with acute angle-closure glaucoma as the first manifestation: A case report. Medicine (Baltimore) 2017; 96:e9201. [PMID: 29390338 PMCID: PMC5815750 DOI: 10.1097/md.0000000000009201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE There were no reports of Miller Fisher syndrome (MFS) with acute angle-closure glaucoma as the first manifestation. PATIENT CONCERNS A 78-year-old female patient was admitted to our hospital with pain in her left eye, blurred vision along with nausea, and vomiting for 2 days. It was extremely rare that ophthalmoplegia, loss of tendon reflexes, and ataxia, did not occur in the early stages of MFS, and initial presentation was only dilated pupis and an increase in intraocular pressure. DIAGNOSES The final diagnosis of the patient was MFS. INTERVENTIONS Intravenous immunoglobulins were administered. OUTCOMES Ophthalmoplegia, walking instability, and ataxia gradually improved. At 3 months follow-up, there was no neurological deficit, and the patient could completely self-care. LESSONS This is the first report of MFS patient with acute angle closure glaucoma as the first manifestation. Consideration should be given to the possibility of incorporating autonomic nervous system dysfunction, or even MFS, in patients with acute angle-closure glaucoma in order to reduce missed diagnosis rate.
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Affiliation(s)
- Jingzhe Han
- Department of Neurology, Harrison International Peace Hospital
| | - Ye Ji
- Department of Neurology, Harrison International Peace Hospital
| | - Duanhua Cao
- Department of Neurology, Harrison International Peace Hospital
| | - Zhilei Kang
- Department of MRI, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Jianguo Zhu
- Department of Neurology, Harrison International Peace Hospital
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25
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Wagner SK, Uddin N, Jain S. The Role of Botulinum Toxin in the Management of Ophthalmoplegia Secondary to Miller Fisher Syndrome. Neuroophthalmology 2017; 42:153-155. [PMID: 29796048 DOI: 10.1080/01658107.2017.1355925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022] Open
Abstract
Miller Fisher syndrome is an acute demyelinating polyneuropathy classically presenting with ataxia, areflexia, and ophthalmoplegia. The authors report the case of a 27-year-old female, who presented with limb weakness and double vision following a prodromal pharyngitis. Ophthalmic examination revealed fluctuant ophthalmoplegia eventually consistent with bilateral sixth cranial nerve palsies, prompting investigation for anti-ganglioside antibodies, which returned positive. Due to disabling diplopia, the patient was treated with botulinum toxin, with a resulting favourable reduction in the size of strabismus. Four months following her presentation, the patient was orthophoric and resumed normal activities.
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Affiliation(s)
- Siegfried K Wagner
- Department of Ophthalmology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Nabil Uddin
- Department of Ophthalmology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Saurabh Jain
- Department of Ophthalmology, Royal Free Hospital NHS Foundation Trust, London, UK
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26
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Incomplete Miller—Fisher syndrome with advanced stage Burkitt lymphoma. Indian Pediatr 2017; 54:413-415. [DOI: 10.1007/s13312-017-1116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Bidot S, Biousse V. [Diplopia: An important symptom in internal medicine!]. Rev Med Interne 2017; 38:806-816. [PMID: 28325621 DOI: 10.1016/j.revmed.2017.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/21/2017] [Indexed: 11/25/2022]
Abstract
Diplopia is defined as "double vision" when looking at a single object. Monocular diplopia is related to an ocular disorder and must be differentiated from binocular diplopia which is secondary to ocular misalignment. The examination of the patient with binocular diplopia is often challenging for non-specialists. However, a careful and systematic clinical examination followed by targeted ancillary testing allows the clinician to localize the lesion along the oculomotor pathways. The lesion may involve the brainstem, the ocular motor nerves III, IV or VI, the neuromuscular junction, the extraocular ocular muscles, or the orbit. Causes of binocular diplopia are numerous and often include disorders typically managed by internal medicine such as inflammatory, infectious, neoplastic, endocrine, and metabolic disorders. In addition to treating the underlying disease, it is important not to leave diplopia uncorrected. Temporary occlusion of one eye by applying tape on one lens or patching one eye relieves the diplopia until more specific treatments are offered should the diplopia not fully resolve.
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Affiliation(s)
- S Bidot
- Fondation ophtalmologique Adolphe-de-Rothschild, 75019 Paris, France; Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 75571 Paris, France
| | - V Biousse
- Services d'ophtalmologie et de neurologie, Emory university school of medicine, Atlanta, GA, États-Unis.
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28
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Abstract
Miller Fisher syndrome (MFS) was first recognized by James Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. Later, it was described in 1956 by Charles Miller Fisher as a possible variant of Guillain-Barré syndrome (GBS). Here, we write a case of a patient with atypical presentation of this clinical triad as the patient presented with double vision initially due to unilateral ocular involvement that progressed to bilateral ophthalmoplegia. He developed weakness of the lower extremities and areflexia subsequently. A diagnosis of MFS was made due to the clinical presentation and the presence of albuminocytologic dissociation in the cerebrospinal fluid (CSF) along with normal results of brain imaging and blood workup. The patient received intravenous immune globulin (IVIG), and his symptoms improved. The initial diagnosis of MFS is based on the clinical presentation and is confirmed by cerebral spinal fluid analysis and clinical neurophysiology studies. This case which emphasizes the knowledge of a rare syndrome can help narrow down the differentials to act promptly and appropriately manage such patients.
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Affiliation(s)
- Sumera Bukhari
- Internal Medicine, Seton Hall University-St. Francis Medical Center, Trenton, NJ
| | - Javier Taboada
- Neurology, Seton Hall University-St. Francis Medical Center, Trenton, NJ
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29
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Salehi N, Choi ED, Garrison RC. A Case of Miller Fisher Syndrome, Thromboembolic Disease, and Angioedema: Association or Coincidence? AMERICAN JOURNAL OF CASE REPORTS 2017; 18:52-59. [PMID: 28090073 PMCID: PMC5260666 DOI: 10.12659/ajcr.901940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Miller Fisher Syndrome is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia, and is considered to be a variant of Guillain-Barre Syndrome. Miller Fisher Syndrome is observed in approximately 1-5% of all Guillain-Barre cases in Western countries. Patients with Miller Fisher Syndrome usually have good recovery without residual deficits. Venous thromboembolism is a common complication of Guillain-Barre Syndrome and has also been reported in Miller Fisher Syndrome, but it has generally been reported in the presence of at least one prothrombotic risk factor such as immobility. A direct correlation between venous thromboembolism and Miller Fisher Syndrome or Guillain-Barre Syndrome has not been previously described. CASE REPORT We report the case of a 32-year-old Hispanic male who presented with acute, severe thromboembolic disease and concurrently demonstrated characteristic clinical features of Miller Fisher Syndrome including ophthalmoplegia, ataxia, and areflexia. Past medical and family history were negative for thromboembolic disease, and subsequent hypercoagulability workup was unremarkable. During the course of hospitalization, the patient also developed angioedema. CONCLUSIONS We describe a possible association between Miller Fisher Syndrome, thromboembolic disease, and angioedema.
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Affiliation(s)
- Nooshin Salehi
- Department of Medicine, Riverside University Health System, Moreno Valley, CA, USA
| | - Eric D Choi
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Roger C Garrison
- Department of Medicine, Riverside University Health System, Moreno Valley, CA, USA.,School of Medicine, Loma Linda University, Loma Linda, CA, USA
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30
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St Charles JL, Bell JA, Gadsden BJ, Malik A, Cooke H, Van de Grift LK, Kim HY, Smith EJ, Mansfield LS. Guillain Barré Syndrome is induced in Non-Obese Diabetic (NOD) mice following Campylobacter jejuni infection and is exacerbated by antibiotics. J Autoimmun 2016; 77:11-38. [PMID: 27939129 DOI: 10.1016/j.jaut.2016.09.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 08/25/2016] [Accepted: 09/04/2016] [Indexed: 01/10/2023]
Abstract
Campylobacter jejuni is a leading cause of bacterial gastroenteritis linked to several serious autoimmune sequelae such as the peripheral neuropathies Guillain Barré syndrome (GBS) and Miller Fisher syndrome (MFS). We hypothesized that GBS and MFS can result in NOD wild type (WT) mice or their congenic interleukin (IL)-10 or B7-2 knockouts secondary to C. jejuni infection. Mice were gavaged orally with C. jejuni strains HB93-13 and 260.94 from patients with GBS or CF93-6 from a patient with MFS and assessed for clinical neurological signs and phenotypes, anti-ganglioside antibodies, and cellular infiltrates and lesions in gut and peripheral nerve tissues. Significant increases in autoantibodies against single gangliosides (GM1, GQ1b, GD1a) occurred in infected NOD mice of all genotypes, although the isotypes varied (NOD WT had IgG1, IgG3; NOD B7-2-/- had IgG3; NOD IL-10-/- had IgG1, IgG3, IgG2a). Infected NOD WT and NOD IL-10-/- mice also produced anti-ganglioside antibodies of the IgG1 isotype directed against a mixture of GM1/GQ1b gangliosides. Phenotypic tests showed significant differences between treatment groups of all mouse genotypes. Peripheral nerve lesions with macrophage infiltrates were significantly increased in infected mice of NOD WT and IL-10-/- genotypes compared to sham-inoculated controls, while lesions with T cell infiltrates were significantly increased in infected mice of the NOD B7-2-/- genotype compared to sham-inoculated controls. In both infected and sham inoculated NOD IL-10-/- mice, antibiotic treatment exacerbated neurological signs, lesions and the amount and number of different isotypes of antiganglioside autoantibodies produced. Thus, inducible mouse models of post-C. jejuni GBS are feasible and can be characterized based on evaluation of three factors-onset of GBS clinical signs/phenotypes, anti-ganglioside autoantibodies and nerve lesions. Based on these factors we characterized 1) NOD B-7-/- mice as an acute inflammatory demyelinating polyneuropathy (AIDP)-like model, 2) NOD IL-10-/- mice as an acute motor axonal neuropathy (AMAN)-like model best employed over a limited time frame, and 3) NOD WT mice as an AMAN model with mild clinical signs and lesions. Taken together these data demonstrate that C. jejuni strain genotype, host genotype and antibiotic treatment affect GBS disease outcomes in mice and that many disease phenotypes are possible.
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Affiliation(s)
- J L St Charles
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Comparative Medicine and Integrative Biology Graduate Program, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - J A Bell
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - B J Gadsden
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Comparative Medicine and Integrative Biology Graduate Program, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - A Malik
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - H Cooke
- College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - L K Van de Grift
- College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - H Y Kim
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA
| | - E J Smith
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - L S Mansfield
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA.
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31
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Abstract
Blepharoptosis or drooping of upper eye lid is a common, but non-specific sign of neurological diseases which sometimes could herald a life-threatening disorder. First, the diagnosis of ptosis should be established by considering four clinical measurements: palpebral fissure height, marginal reflex distance, upper eyelid crease, and levator function test. The diagnostic categories of ptosis are scheduled as pseudo-ptosis, congenital, and acquired ptosis. Acquired causes include mechanical, myogenic, neuromuscular, neurogenic, and cerebral. Each category with diseases presenting with ptosis was described in detail. Considering some features, such as involvement of other cranial nerves, extraocular muscle, pupil size and reactivity, and unilateral or bilateral presentation of ptosis, could help to narrow the differential diagnosis.
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Ryu WY, Kim JK, Jin SW, Shim DH. Acute angle-closure glaucoma in a patient with miller fisher syndrome without pupillary dysfunction. J Glaucoma 2014; 24:e5-6. [PMID: 25393040 DOI: 10.1097/ijg.0000000000000191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a case of an angle-closure glaucoma in a patient with Miller Fisher syndrome (MFS) without pupillary dysfunction. METHODS We present a case report of a 75-year-old male presenting with total ophthalmoplegia, complete bilateral ptosis, and gait disturbance. He was diagnosed with MFS without pupillary dysfunction, which precipitated unilateral acute angle-closure glaucoma (AACG) due to complete lid ptosis. RESULTS The initial ocular examination revealed hand motion in the right eye. Intraocular pressure, as assessed by Goldmann applanation tonometry, was 50 mm Hg, and gonioscopic findings revealed a closed angle on the right eye. After maximal tolerated medical therapy, laser peripheral iridotomy was performed. The unilateral AACG with MFS resolved without further incident. CONCLUSIONS This is the first reported case of a patient with MFS without autonomic dysfunction and AACG. We believe that pupillary dysfunction or lid ptosis due to neurological disorders may increase the possibility of AACG.
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Affiliation(s)
- Won Yeol Ryu
- Departments of *Ophthalmology †Neurology, Dong-A University College of Medicine, Busan, Republic of Korea
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33
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Internal ophthalmoplegia as the initial symptom of Miller-Fisher syndrome. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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34
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Adam MK, Krespan K, Moster ML, Sergott RC. Simultaneous, Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis. Neuroophthalmology 2014; 38:230-237. [DOI: 10.3109/01658107.2014.902972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 12/18/2022] Open
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35
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Tzachanis D, Hamdan A, Uhlmann EJ, Joyce RM. Successful treatment of refractory Guillain-Barré syndrome with alemtuzumab in a patient with chronic lymphocytic leukemia. Acta Haematol 2014; 132:240-3. [PMID: 24853856 DOI: 10.1159/000358292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/02/2014] [Indexed: 12/19/2022]
Abstract
This is the case of a 79-year-old man with chronic lymphocytic leukemia who presented with Guillain-Barré syndrome with features overlapping with the Miller Fisher syndrome and Bickerstaff brainstem encephalitis and positive antiganglioside GQ1b antibody about 6 months after treatment with bendamustine and rituximab. His clinical and neurologic condition continued to deteriorate despite sequential treatment with corticosteroids, intravenous immunoglobulin and plasmapheresis, but in the end, he had a complete and durable response to treatment with alemtuzumab.
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MESH Headings
- Aged
- Alemtuzumab
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antigens, CD/immunology
- Antigens, Neoplasm/immunology
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Autoantibodies/blood
- Autoantibodies/immunology
- Autoantigens/immunology
- Bendamustine Hydrochloride
- CD52 Antigen
- Combined Modality Therapy
- Consciousness Disorders/drug therapy
- Consciousness Disorders/etiology
- Consciousness Disorders/therapy
- Gangliosides/immunology
- Glycoproteins/antagonists & inhibitors
- Glycoproteins/immunology
- Guillain-Barre Syndrome/drug therapy
- Guillain-Barre Syndrome/etiology
- Guillain-Barre Syndrome/therapy
- Herpes Zoster/complications
- Herpesvirus 3, Human/physiology
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Methylprednisolone/therapeutic use
- Miller Fisher Syndrome/drug therapy
- Miller Fisher Syndrome/etiology
- Miller Fisher Syndrome/therapy
- Nitrogen Mustard Compounds/administration & dosage
- Nitrogen Mustard Compounds/adverse effects
- Plasmapheresis
- Remission Induction
- Rituximab
- Virus Activation
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36
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Esquinas Requena JL, Fernández Martínez N, Martín Márquez J, Mazoteras Muñoz V, Martinón Torres G. [An atypical variant of Guillain-Barré syndrome: presentation of a case]. Rev Esp Geriatr Gerontol 2014; 49:91-93. [PMID: 24513438 DOI: 10.1016/j.regg.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 11/27/2013] [Indexed: 06/03/2023]
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37
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Cho BJ, Kim JS, Hwang JM. Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis. KOREAN JOURNAL OF OPHTHALMOLOGY 2013; 27:474-7. [PMID: 24311937 PMCID: PMC3849315 DOI: 10.3341/kjo.2013.27.6.474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/14/2012] [Indexed: 11/23/2022] Open
Abstract
A 55-year-old woman presented with diplopia following painful skin eruptions on the right upper extremity. On presentation, she was found to have 35 prism diopters of esotropia and an abduction limitation in the left eye. Two weeks later, she developed blepharoptosis and anisocoria with a smaller pupil in the right eye, which increased in the darkness. Cerebrospinal fluid analysis showed pleocytosis and a positive result for immunoglobulin G antibody to varicella zoster virus. She was diagnosed to have zoster meningitis with Horner's syndrome and contralateral abducens nerve palsy. After intravenous antiviral and steroid treatments, the vesicular eruptions and abducens nerve palsy improved. Horner's syndrome and diplopia resolved after six months. Here we present the first report of Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis.
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Affiliation(s)
- Bum-Joo Cho
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
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38
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Internal ophthalmoplegia as the initial symptom of Miller-Fisher syndrome. Neurologia 2013; 29:504-5. [PMID: 24075583 DOI: 10.1016/j.nrl.2013.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 04/25/2013] [Accepted: 06/01/2013] [Indexed: 11/20/2022] Open
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Kaymakamzade B, Selcuk F, Koysuren A, Colpak AI, Mut SE, Kansu T. Pupillary Involvement in Miller Fisher Syndrome. Neuroophthalmology 2013; 37:111-115. [PMID: 28163765 DOI: 10.3109/01658107.2013.792356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/03/2013] [Accepted: 03/04/2013] [Indexed: 11/13/2022] Open
Abstract
Miller Fisher Syndrome is characterised by the classical triad of ophthalmoplegia, ataxia, and areflexia. Ophthalmoparesis without ataxia, without areflexia, or with neither have been attributed as atypical forms of MFS. We report two patients with MFS who had tonic pupils and raised anti-GQ1b antibody titres. Bilateral dilated pupils (either tonic or fixed) can be a manifestation of MFS and anti-GQ1b immunoglobulin G (IgG) antibodies are useful to confirm the diagnosis in unexplained cases. The site of involvement is thought to be the ciliary ganglion or short ciliary nerves.
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Affiliation(s)
- Bahar Kaymakamzade
- Department of Neurology, Dr. Burhan Nalbantoglu State Hospital, Nicosia Northern Cyprus Cyprus
| | - Ferda Selcuk
- Department of Neurology, Dr. Burhan Nalbantoglu State Hospital, Nicosia Northern Cyprus Cyprus
| | - Aydan Koysuren
- Department of Neurology, School of Medicine, Hacettepe University Ankara Turkey
| | - Ayse Ilksen Colpak
- Department of Neurology, School of Medicine, Hacettepe University Ankara Turkey
| | - Senem Ertugrul Mut
- Department of Neurology, Dr. Burhan Nalbantoglu State Hospital, Nicosia Northern Cyprus Cyprus
| | - Tulay Kansu
- Department of Neurology, School of Medicine, Hacettepe University Ankara Turkey
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40
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Abstract
PURPOSE.: Miller Fisher syndrome (MFS) is a rare immune-mediated neuropathy that commonly presents with diplopia after the acute onset of complete bilateral external ophthalmoplegia. Ophthalmoplegia is often accompanied by other neurological deficits such as ataxia and areflexia that characterize MFS. Although MFS is a clinical diagnosis, serological confirmation is possible by identifying the anti-GQ1b antibody found in most of the affected patients. We report a patient with MFS who presented with clinical signs suggestive of ocular myasthenia gravis but in whom the correct diagnosis was made on the basis of serological testing for the anti-GQ1b antibody. CASE REPORT.: An 81-year-old white man presented with an acute onset of diplopia after a mild gastrointestinal illness. Clinical examination revealed complete bilateral external ophthalmoplegia and left-sided ptosis. He developed more marked bilateral ptosis, left greater than right, with prolonged attempted upgaze. He was also noted to have a Cogan lid twitch. Same day evaluation by a neuro-ophthalmologist revealed mild left-sided facial and bilateral orbicularis oculi weakness. He had no limb ataxia but exhibited a slightly wide-based gait with difficulty walking heel-to-toe. A provisional diagnosis of ocular myasthenia gravis was made, and anticholinesterase inhibitor therapy was initiated. However, his symptoms did not improve, and serological testing was positive for the anti-GQ1b immunoglobulin G antibody, supporting a diagnosis of MFS. CONCLUSIONS.: Although the predominant ophthalmic feature of MFS is complete bilateral external ophthalmoplegia, it should be recognized that MFS has variable associations with lid and pupillary dysfunction. Such confounding neuro-ophthalmic features require a thorough history, neurological examination, neuroimaging, and serological testing for the anti-GQ1b antibody to arrive at a diagnosis of MFS.
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Guillain-Barré syndrome after influenza vaccination in the United States, a report from the CDC/FDA vaccine adverse event reporting system (1990-2009). J Clin Neuromuscul Dis 2013; 14:66-71. [PMID: 23172385 DOI: 10.1097/cnd.0b013e31824db14e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the rate of Guillain-Barré syndrome (GBS) after administration of influenza vaccine in the United States and to provide further information about the characteristics and temporal profile of these incidents. METHODS Data were acquired from the Vaccine Adverse Event Reporting System, supplemented by data from the Center for Biologics and Research under the Freedom of Information Act between 1990 and 2009. RESULTS There were 802 cases (mean age, 54.72 ± 18.4 years) of GBS reported after influenza vaccination in the United States between 1990 and 2009. Among the 802 vaccinated patients with available data, 624 (77.8%) developed GBS within 6 weeks and 78 (9.7%) after 6 weeks, whereas these data were unavailable for the remaining 100 patients (13%). The reporting rate of post-influenza vaccine GBS was within the range expected in the general population or approximately 0.46 cases per million vaccinations. A non-Gaussian distribution of GBS within the first 6 weeks post-vaccination was noted, given that the peak incidence occurred in the second week. CONCLUSIONS The incidence of post-influenza vaccine GBS is similar to the incidence of idiopathic GBS in the general population. Although the nonnormal distribution of post-vaccination GBS suggests that some cases may be triggered by vaccination, the greater risk of complications from influenza virus infections makes vaccination the first-line strategy for infection prevention and support the current guidelines on vaccination.
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42
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Evliyaoglu F, Karadag R, Burakgazi AZ. Ocular neuropathy in peripheral neuropathies. Muscle Nerve 2012; 46:681-6. [PMID: 23055310 DOI: 10.1002/mus.23414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ocular movements and coordination require complex and integrated functions of somatic and autonomic nervous systems. Neurological disorders affecting these nervous systems may cause ocular dysfunction involving extraocular muscles and pupils. In this article, the prevalence, clinical presentations, and management of ocular neuropathy related to certain peripheral neuropathies, including diabetic neuropathy, Guillain-Barré syndrome (GBS), chronic inflammatory neuropathies, human immunodeficiency virus (HIV)-associated neuropathy, and hereditary neuropathies, are examined in detail.
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Affiliation(s)
- Ferhat Evliyaoglu
- Department of Ophthalmology, Okmeydani Research and Training Hospital, Istanbul, Turkey
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43
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Sheikh AS. Acute Complex Neuroplegia and Ophthalmoplegia
Associated with Anti-GQ1b Antibodies. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2012. [DOI: 10.29333/ejgm/82445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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44
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Analysis of data from the CDC/FDA Vaccine Adverse Event Reporting System (1990-2009) on Guillain-Barre syndrome after hepatitis vaccination in the USA. J Clin Neurosci 2012; 19:1089-92. [DOI: 10.1016/j.jocn.2011.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 11/16/2011] [Accepted: 11/18/2011] [Indexed: 11/21/2022]
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45
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Annan M, Limousin N, Roubeau V, De Toffol B, Praline J. [Mydriasis and velopharyngeal palsy as clinical signs of Miller-Fisher syndrome]. Rev Neurol (Paris) 2012; 168:988-9. [PMID: 22682053 DOI: 10.1016/j.neurol.2012.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 02/28/2012] [Accepted: 03/14/2012] [Indexed: 11/17/2022]
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46
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Kulkarni KM, Pasol J. Bilateral oculomotor synkinesis following Miller Fisher syndrome. Int Ophthalmol 2012; 32:277-80. [PMID: 22407534 DOI: 10.1007/s10792-012-9548-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 02/27/2012] [Indexed: 11/26/2022]
Abstract
A 64-year-old female presented with ptosis, ophthalmoplegia, ataxia, and weakness. She was diagnosed with Miller Fisher syndrome (MFS) and was treated with plasmapheresis. Six months later, she developed bilateral oculomotor synkinesis, suggesting aberrant regeneration. The pathogenesis of MFS is reviewed in light of this unusual finding.
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47
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Abstract
A 55-year-old immunocompetent man presented with headache, nausea, progressive bilateral upper lid ptosis, and diplopia. Examination showed bilateral asymmetric upper lid ptosis with limited adduction and elevation of both eyes. Cranial magnetic resonance imaging revealed enhancing intra-axial and extra-axial midbrain lesions. Blood and cerebrospinal fluid were positive for cryptococcal antigen and cerebrospinal fluid fungal cultures grew Cryptococcus neoformans. Treatment with liposomal amphotericin B and flucytosine resulted in complete resolution of his neurological deficits and lesions on neuroimaging. Patients with cryptococcal meningitis may rarely present with bilateral cranial nerve III dysfunction.
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48
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Zuccoli G, Panigrahy A, Bailey A, Fitz C. Redefining the Guillain-Barré spectrum in children: neuroimaging findings of cranial nerve involvement. AJNR Am J Neuroradiol 2011; 32:639-42. [PMID: 21292802 PMCID: PMC7965877 DOI: 10.3174/ajnr.a2358] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Accepted: 09/06/2010] [Indexed: 12/31/2022]
Abstract
GBS and its MFS variant are acute polyneuropathies that are considered to represent a continuum rather than distinct entities, due to the overlap in their clinical features. Enhancement of the CE roots represents the neuroradiologic hallmark of GBS, while findings of neuroimaging studies in MFS are usually unremarkable. Our purpose was to evaluate the MR imaging findings of polyneuropathy in 17 children affected by GBS and its MFS variant. Fourteen of our 17 patients demonstrated CE enhancement, with predominant involvement of the anterior roots. Of 6 patients who underwent MR imaging of the brain, 5 had cranial nerve involvement. In children affected by GBS-MFS, involvement of the CE roots may be considered part of a more extensive autoimmune neuropathy, as demonstrated by enhancement of cranial nerves. Brain MR imaging should be considered in the routine evaluation in pediatric patients with GBS-MFS for the evaluation of the cranial nerves.
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Affiliation(s)
- G Zuccoli
- Department of Radiology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15224, USA.
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49
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Yıldız ÖK, Balaban H, Özdemir S, Bolayır E, Topaktas S. Anti-GQ1b-Negative Miller Fisher Syndrome with Acute Areflexic Mydriasis and Cholinergic Supersensitivity. Neuroophthalmology 2011; 35:40-42. [PMID: 27956933 DOI: 10.3109/01658107.2010.539761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/03/2010] [Accepted: 09/06/2010] [Indexed: 11/13/2022] Open
Abstract
Miller Fisher syndrome is a rare variant of Guillain-Barré syndrome and it is characterised by ophthalmoplegia, ataxia, and areflexia. Pupillomotor involvement occurs in approximately half of the patients with the disorder. The authors report a patient with acute areflexic mydriasis, external ophthalmoplegia, areflexia, and ataxia. Although the pupils were unreactive to light and near stimuli, administration of 0.1% pilocarpine resulted in marked miosis, suggesting cholinergic supersensitivity. Antibodies against GM1, GD1b, and GQ1b were negative. This is the first report of acute areflexic mydriasis with cholinergic supersensitivity in anti-GQ1b-negative Miller Fisher syndrome.
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Affiliation(s)
- Özlem Kayım Yıldız
- Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Hatice Balaban
- Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Sibel Özdemir
- Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ertuğrul Bolayır
- Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Suat Topaktas
- Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey
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50
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Vermeersch G, Boschi A, Deggouj N, van Pesch V, Sindic C. Recurrent Miller Fisher Syndrome with Vestibular Involvement. Eur Neurol 2011; 66:210-4. [DOI: 10.1159/000331486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 07/14/2011] [Indexed: 11/19/2022]
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