Miller Fisher Syndrome: A Case Report of an Uncommon Disease

Miller Fisher syndrome (MFS) is considered a variant of Guillian-Barré syndrome (GBS) characterized by the triad of ophthalmoplegia, ataxia and arreflexia. It is an uncommon disorder with an estimated incidence of 1 to 5% of the total GBS cases in Western countries.

We describe a 15 year-old female who came to the emergency department complaining of dizziness, unsteady gait, diplopia and pain in the hands and feet with a few hours of evolution. The patient reported vomiting and diarrhoea about two weeks before symptom onset. Her vital signs were normal. The neurological assessment revealed bilateral VI nerve palsy, ataxic broad-based gait, arreflexia and limb dysesthesia. Lower limb strength was slightly reduced. Routine blood tests were normal. Cerebrospinal fluid examination didn’t show albuminocytologic dissociation (first day of disease) and was negative for the presence of oligoclonal bands, gram stain, culture and polymerase chain reaction for neurotropic viruses. Cranial and medullar magnetic resonance imaging was normal with no cranial nerve enhancement or thickening of the cauda equina. The serologic study revealed evidence of acute infection by Coxsackie virus. The electromyography was normal and serum anti-gangliosides and anti-neuronal antibodies were negative. The patient received intravenous immune globulin with clinical improvement noticed at day two of treatment. Complete recovery was achieved in four months.

MFS is a rare, self-limiting condition and its diagnosis is based on the presence of the typical clinical triad. The albuminocytological dissociation is not present in a majority of cases in the first week of symptoms. Although usually benign, it is important to know this syndrome and how to manage it in order to narrow the differential diagnoses and act properly and promptly.