Case report
Recurrent Miller–Fisher syndrome

https://doi.org/10.1016/j.jocn.2003.03.006Get rights and content

Abstract

A case of recurrent Miller–Fisher syndrome is presented and features of this very rare condition are discussed.

Introduction

Miller–Fisher syndrome (MFS) is an uncommon variant of Guillain–Barre syndrome (GBS). Recurrences of GBS are well documented but repeated episodes of MFS are very rarely seen in clinical practice.1 We describe a case of recurrent Miller–Fisher Syndrome where three similar episodes occurred with complete recovery between each over a twelve-year period.

Section snippets

Case history

In June 1989 a previously well 57-year-old male developed subacute onset of acral paraesthesia and numbness, associated with lethargy and headache three days after an upper respiratory tract infection (URTI). The symptoms progressed over the next four days and the patient presented to emergency with a drooping left eyelid, double vision, and difficulty in walking. Examination demonstrated a left ptosis, loss of horizontal gaze and sparing of vertical gaze. Pupillary responses were normal and

Discussion

Miller–Fisher syndrome is a clinical variant of Guillain–Barre Syndrome. The classical triad of symptoms consists of ataxia, areflexia and ophthalmoplegia, although other cranial nerves can be involved and there is frequently a degree of peripheral sensory and motor disturbance.3 Both GBS and MFS share a number of features: increased cerebrospinal fluid protein with mild or absent pleocytosis, responsiveness to immune modulatory therapies, and association with various antecedent infections

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