scholarly journals Miller Fisher syndrome following BNT162b2 mRNA coronavirus 2019 vaccination

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yamato Nishiguchi ◽  
Hirofumi Matsuyama ◽  
Kuniko Maeda ◽  
Akihiro Shindo ◽  
Hidekazu Tomimoto
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Miller Fisher Syndrome ◽  
Cerebrospinal Fluid Analysis ◽  
Fisher Syndrome ◽  
Case Presentation ◽  
Fluid Analysis ◽  
Positron Emission ◽  
Limb Ataxia ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in late 2019. One of the vaccines approved against COVID-19 is the BNT162b2 mRNA COVID-19 vaccine (Pfizer/BioNTech). Case presentation We present the case of a 71-year-old man with no history of the SARS-CoV-2 infection or any recent viral or bacterial illnesses who presented with bilateral oculomotor palsy and limb ataxia after BNT162b2 mRNA COVID-19 vaccination. The diagnosis of Miller Fisher syndrome (MFS) was established based on physical examination, brain magnetic resonance imaging (MRI), cerebrospinal fluid analysis (CSF), and positron emission tomography (PET). There was no evidence of other predisposing infectious or autoimmune factors, and the period from COVID-19 vaccination to the appearance of neurological symptoms was similar to that of other vaccines and preceding events, such as infection. Conclusion Guillain–Barré syndrome (GBS) and its variants after COVID-19 vaccination are extremely rare. Note that more research is needed to establish an association between MFS and COVID-19 vaccines. In our opinion, the benefits of COVID-19 vaccination largely outweigh its risks.

scholarly journals Miller Fisher Syndrome presenting as unilateral abducens nerve palsy: A case report

2019 ◽  
Author(s):  
Neomal Sawanawadu Dilantha De Silva ◽  
Suranga Singhapathirana ◽  
Chintaka Eshan De Silva
Keyword(s):  
Nerve Palsy ◽  
Abducens Nerve ◽  
Miller Fisher Syndrome ◽  
Abducens Nerve Palsy ◽  
Fisher Syndrome ◽  
Fluid Analysis ◽  
Excellent Functional Outcome ◽  
History Of ◽  
F Wave ◽  
Complete Ophthalmoplegia

Abstract Background : Miller Fisher Syndrome usually presents with complete ophthalmoplegia, areflexia and ataxia. We present an unusual case which presented with unilateral abducens nerve palsy. Case presentation : A 51 year old female patient presented with a history of difficulty in walking and double vision for 1 week which started 2 weeks following an episode of acute gastroenteritis. She didn’t have any bladder bowel incontinence or difficulty in breathing. On examination there was left side abducens nerve palsy and bilateral significant dysmetria. Upper limb and lower limb power was 4/5 with global areflexia. There was no fatigability or sensory deficit. Higher cortical functions were intact with Glasgow Coma Scale of 15/15. Brain stem cerebro vascular accident, alcohol, toxin or drug mediated disease, myasthenia gravis, Bickerstaff encephalitis and Miller-Fisher syndrome were considered as possible differential diagnosis. There was no history of alcohol consumption or any exposure to drugs or toxins. Her Non contrast brain and MRI brain were normal. Nerve conduction study showed asymmetrical sensory motor and F wave abnormalities consistent with a Guillen-Barre Sydrome variant. Cerebro Spinal Fluid analysis showed albumino-cytological dissociation. These findings suggested the diagnosis of Miller-Fisher Syndrome. She was started on plasmaphareis. Her vital parameters, vital capacity and neurological deficit were closely monitored. With 5 cycles of plasmapharesis she made a complete neurological recovery and she was discharged on 16th day of admission. Conclusion: Miller Fisher Syndrome can present as unilateral abducens nerve palsy and early diagnosis and treatment leads to excellent functional outcome.

scholarly journals Association Between Novel Coronavirus Disease 2019 (COVID-19) and Idiopathic Intracranial Hypertension

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ahmad Talebian ◽  
Babak Soltani ◽  
Dawood Aghadoost ◽  
Javid Azadbakht ◽  
Alireza Rezaee ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Neurological Complication ◽  
Brain Magnetic Resonance Imaging ◽  
Pseudotumor Cerebri ◽  
Normal Brain ◽  
Fluid Analysis ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Novel Coronavirus

Introduction: Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a rare neurological manifestation of coronavirus disease 2019 (COVID-19) infection. Case Presentation: In this case study, we present a 10-year-old girl with headache, diplopia, bilateral sixth nerve palsy, and papilledema following a history of seven days of fever about two weeks ago. In lumbar puncture, the opening pressure was 56 cmH2O. Cerebrospinal fluid analysis was normal. Brain magnetic resonance imaging (MRI) was suggestive of IIH. Nasopharyngeal reverse transcription-polymerase chain reaction (RT-PCR) was positive for COVID-19. Oral acetazolamide was prescribed, and the patient improved completely after three weeks of continuous medical treatment. Conclusions: Since IIH is a rare neurological complication of COVID-19, we have to suspect COVID-19 infection in any patient with IIH.

scholarly journals New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review

2021 ◽  
Vol 9 ◽  
pp. 232470962098630
Author(s):  
Riwaj Bhagat ◽  
Barbara Kwiecinska ◽  
Nolan Smith ◽  
Matthew Peters ◽  
Christopher Shafer ◽  
...  
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Nasopharyngeal Swab ◽  
Onset Seizure ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Global Pandemic ◽  
Elevated Protein ◽  
T2 Hyperintensity ◽  
Elevated Protein Level ◽  
New Onset

With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.

Abdominopelvic Pain in Patient with Uterus Didelphys and Unilateral Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA Syndrome)

2021 ◽  
Author(s):  
Zahra Tavoli ◽  
Ali Montazeri
Keyword(s):  
Renal Agenesis ◽  
Primary Diagnosis ◽  
Case Presentation ◽  
Uterus Didelphys ◽  
Future Fertility ◽  
History Of ◽  
Ohvira Syndrome ◽  
Obstructed Hemivagina ◽  
Magnetic Resonance Imaging Mri

Introduction: Uterus didelphys with obstructed hemivagina associated with ipsilateral renal agenesis (OHVIRA syndrome) is a rare female urogenital malformation and delay in its diagnosis could lead to several complications. Case presentation: A 21-year-old virgin woman was admitted to the emergency department (ED) with severe abdominal pain, without fever and vaginal discharge. She reported a history of cyclic abdominopelvic pain and dysmenorrhea for 5 years. The primary diagnosis (OHVIRA syndrome) was made using ultrasonography, spiral computed tomography (CT) and magnetic resonance imaging (MRI). In addition, laparoscopy was performed to confirm diagnosis and drain hematosalpinx. Then, hysteroscopy was carried out for septum resection and catheter insertion. At one-month follow-up the ultrasonography showed normal left hemicavity of uterus associated with significant decrease in dysmenorrhea. Conclusion: Being aware of OHVIRA syndrome and clinical suspicion of this rare anomaly are essential for making a timely diagnosis, preventing complications, relieving symptoms, and preserving future fertility.

Posterior reversible encephalopathy syndrome following Miller-Fisher syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e242231
Author(s):  
Catarina Bernardes ◽  
Cristiana Silva ◽  
Gustavo Santo ◽  
Inês Correia
Keyword(s):  
Intravenous Immunoglobulin ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Brain Mri ◽  
Clonic Seizure ◽  
Miller Fisher Syndrome ◽  
Fisher Syndrome ◽  
Posterior Reversible Encephalopathy ◽  
Fluid Analysis ◽  
Immunoglobulin Treatment ◽  
Reversible Encephalopathy

A 71-year-old woman presented to the emergency room with dysphonia, diplopia, dysphagia and generalised weakness since that day. Neurological examination revealed eye adduction limitation, ptosis, hypoactive reflexes and gait ataxia. Blood and cerebrospinal fluid analysis and brain CT were normal. Electromyography revealed a sensory axonal polyneuropathy. She was diagnosed with Miller-Fisher syndrome (MFS) and started on intravenous immunoglobulin. Two days after intravenous immunoglobulin treatment was completed, she developed a sustained hypertensive profile and presented a generalised tonic-clonic seizure. Brain MRI was suggestive of posterior reversible encephalopathy syndrome (PRES) and supportive treatment was implemented with progressive improvement. PRES may be a possible complication of MFS not only due to autonomic and inflammatory dysfunctions, but also as a consequence of its treatment. Patients with MFS should be maintained under close surveillance, especially in the first days and preferably in intermediate care units.

scholarly journals Acute Bilateral Ophthalmoparesis with Pupilary Areflexical Mydriasis in Miller-Fisher Syndrome Treated with Intravenous Immunoglobulin

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Theocharis Papanikolaou ◽  
Cath Gray ◽  
Bernard Boothman ◽  
Gerald Naylor ◽  
George Mariatos
Keyword(s):  
Intravenous Immunoglobulin ◽  
Nerve Palsy ◽  
Rare Condition ◽  
Miller Fisher Syndrome ◽  
Uneventful Recovery ◽  
Fisher Syndrome ◽  
History Of ◽  
Classical Triad ◽  
Fourth Nerve Palsy ◽  
Sixth Nerve

Miller-Fisher syndrome (MFS) is a rare condition characterized by the classical triad of ophthalmoplegia, ataxia, and areflexia (Fisher, 1956). It is considered a variant of Guillain-Barré syndrome (GBS) with which it may overlap, or it can occur in more limited forms. We report a case of a thirty-five-year-old male who presented with a six-day history of diplopia, following a recent chest infection. On examination, he was found to have bilateral sixth nerve palsy, bilateral fourth nerve palsy, bilateral areflexical mydriasis, ataxia and total absence of reflexes. After excluding other conditions, a diagnosis of Miller-Fisher syndrome was made. The patient was administered intravenous immunoglobulin and made an uneventful recovery.

De novo convulsive status epilepticus in patients with multiple sclerosis treated with dalfampridine

2018 ◽  
Vol 25 (4) ◽  
pp. 618-621 ◽  
Author(s):  
Emilie Panicucci ◽  
Mikael Cohen ◽  
Veronique Bourg ◽  
Fanny Rocher ◽  
Pierre Thomas ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Status Epilepticus ◽  
De Novo ◽  
Case Reports ◽  
Brain Magnetic Resonance Imaging ◽  
Convulsive Status Epilepticus ◽  
Biological Tests ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
History Of Epilepsy

Background: Dalfampridine extended release (DAL) is a broad-spectrum voltage-gated potassium channel blocker that is indicated in multiple sclerosis to improve the nerve conduction of demyelinated axons. Seizures are a known side effect of DAL, which is contraindicated in patients with a history of epilepsy. Objective: Three cases of multiple sclerosis (MS) with de novo convulsive status epilepticus (CSE) probably related to dalfampridine administration are described. Methods: No patients had a history of seizures or renal impairment. Biological tests were normal. A brain magnetic resonance imaging (MRI) showed diffuse cortical and subcortical atrophy without active inflammatory lesions. Results: All three patients presented with CSE that was attributed to DAL and so was discontinued. Conclusion: These case reports illustrate that, aside from seizures, de novo CSE is a potential complication of MS patients treated with DAL.

The Differentiation between Pancreatic Neoplastic Cysts and Pancreatic Pseudocyst

2005 ◽  
Vol 94 (2) ◽  
pp. 161-164 ◽  
Author(s):  
J. Sand ◽  
I. Nordback
Keyword(s):  
Pancreatic Pseudocyst ◽  
Emission Tomography ◽  
Cystic Lesions ◽  
Imaging Studies ◽  
Cystic Neoplasms ◽  
Fluid Analysis ◽  
Positron Emission ◽  
Serous Cystadenomas ◽  
History Of ◽  
Quality Imaging

The number of small and often asymptomatic cystic lesions detected in pancreas has increased during the last decade. Historically the vast majority of the pancreatic cystic lesions were considered pseudocysts, but in recent series the incidence of various neoplastic cysts, such as intraductal papillary mucinous neoplasm, serous cystadenomas and cystic endocrine tumours, has increased. The possible malignant potential in these cystic neoplasms warrants careful diagnostic workup to choose the optimal treatment for each patient. Patient's age, symptoms and a possible history of acute or chronic pancreatitis with known aetiology together with high quality imaging studies are important in the differential diagnosis between pseudocysts and neoplastic cysts. Endoscopic ultrasound, cyst fluid analysis and positron emission tomography may be used in selected patients, but the accuracy of these methods needs further investigation.

Unusual presentation of acute encephalopathy with biphasic seizures and late reduced diffusion in Miller–Dieker syndrome

2019 ◽  
Author(s):  
Satoru Kobayashi ◽  
Mai Kamishima ◽  
Akari Tago ◽  
Kyoko Yokoi ◽  
Satoshi Suzuki
Keyword(s):  
Brain Magnetic Resonance Imaging ◽  
Subcortical White Matter ◽  
Acute Encephalopathy ◽  
Case Presentation ◽  
Delta Waves ◽  
Diffusion Weighted Images ◽  
Disturbance Of Consciousness ◽  
Intravenous Diazepam ◽  
Severe Motor ◽  
Magnetic Resonance Imaging Mri

Abstract Background: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a unique subtype of acute encephalopathy that occurs in children. To date, there is no description of a patient with concurrent Miller–Dieker syndrome (MDS) and AESD. Case presentation: We present a case of 2-year-old girl with MDS, who was admitted for status epilepticus with a high fever, was diagnosed with AESD. She exhibited seizure for more than 1 h, which disappeared after administration of intravenous diazepam and phenobarbital. Brain magnetic resonance imaging (MRI), performed on the third day post-admission because she had not regained consciousness after the seizure ceased, showed abnormally high intensities in subcortical white matter, predominantly in the frontal areas on diffusion-weighted images (DWI). Acute encephalitis/encephalopathy was diagnosed based on electroencephalography (EEG) findings of diffuse high-voltage delta waves without seizure activity. Six days post-admission, frequent apneic episodes were observed, with oxygen desaturation due to clustered seizures. Although seizures disappeared with continuous intravenous midazolam, subclinical seizures were present in amplitude-integrated EEG (aEEG); these were suppressed by increasing the midazolam dose. Conclusion: This is the first report of AESD in a patient with MDS. Ther disturbance of consciousness was difficult to recognize because of severe motor and intellectual disabilities due to MDS. EEG aids the evaluation of consciousness in the acute phase, and aEEG can be helpful for monitoring and controlling subclinical seizures in the biphasic phase of AESD, especially patients with underlying neurological disorders.

scholarly journals Hypertrophic olivary degeneration concomitant with bilateral middle cerebellar peduncles Wallerian degeneration following unilateral pontine infarction

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bing Bao ◽  
Xiangbin Wu ◽  
Zhongbin Xia ◽  
Yaoyao Shen
Keyword(s):  
Wallerian Degeneration ◽  
Corticospinal Tract ◽  
Brain Magnetic Resonance Imaging ◽  
Acute Onset ◽  
Case Presentation ◽  
Hypertrophic Olivary Degeneration ◽  
Pontine Infarction ◽  
Cerebellar Peduncles ◽  
Magnetic Resonance Imaging Mri

Abstract Background Wallerian degeneration (WD) can occur in different projecting systems, such as corticospinal tract, dentate-rubro-olivary pathway, and corticopontocerebellar tract. However, the co-occurrence of hypertrophic olivary degeneration (HOD) and middle cerebellar peduncles (MCPs) degeneration secondary to unilateral pontine infarction in a single patient is extremely rare. Case presentation A 71-year-old man presented with acute onset of dizzness, slurred speech, and right-sided weakness. On the next day, his previous neurologic deficits deteriorated. Brain magnetic resonance imaging (MRI) revealed acute ischemic stroke of the left pons. After treatment with thrombolysis, antiplatelets, and rehabilitation training, his speaking and motor function improved moderately. At the 3-month follow-up, the MRI showed hyperintensity in the left medulla oblongata and bilateral MCPs on T2-weighted and FLAIR images, suggesting HOD as well as MCPs degeneration. Conclusions It is of great importance for us to know the anatomic knowledge of dentate-rubro-olivary and corticopontocerebellar pathways.

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