Miller Fisher Syndrome: A Case Report

Miller Fisher syndrome (MFS), also known as Fisher syndrome and the Miller Fisher Variant
of Guillain-Barré syndrome, is an autoimmune, antibody mediated neurologic disorder. MFS
typically presents as a monophasic, self-resolving triad of ophthalmoplegia, ataxia, and
areflexia. MFS is closely related to other diseases such as Guillain-Barré syndrome,
Bickerstaff brainstem encephalopathy, and acute ophthalmoparesis, collectively known as the
anti-GQ1b syndromes.
Case presentation:
48 year old male presented with 3 days history of numbness of both feet , unsteadiness while
walking , weakness of lower limbs and diplopia . His neurological examination revealed
bilateral ptosis , 3rd , 4th , 6th and 7th cranial nerve abnormalities and decreased power of both
lower limbs with areflexia .csf analysis demonistrated albuminocytological dissociation with
high protein 173 mg/dl , sugar 79 mg/dl with no cells . Mri of brain and spine did not show
any acute findings . Nerve conduction study severe length dependent symmetrical
demyelinating polyneuropathy . Anti GQ1B antibodies were not done due to lack of facility
in our hospital . Short course of steroid was initiated intravenously and he showed marked
clinical improvement . Later on he discharged with full extra-ocular movement and power of
all 4 limbs
Conclusion :
Miller-Fisher syndrome is known for the characteristic triad of opthalmoplegia, ataxia, and
areflexia . It is considered a variant of GBS. An increasing body of evidence suggests that a
rather wide range of neurological features may be present and significant overlap exists in
MFS and other forms of GBS. MFS seems to more notably affect the peripheral nervous
system, yet evidence of central elements has also been reported.. Although the defining
features are generally required for the diagnosed as MFS, other symptoms and signs may be
present and confound a clinician's diagnostic decision making.