scholarly journals Anti-Ganglioside Antibody Negative Miller Fisher Syndrome with Atypical Features: A Case Report

Author(s):  
Naresh Kumar ◽  

Miller Fisher Syndrome (MFS), a variant of Guillain Barre Syndrome (GBS), is an immune-mediated neuropathy presenting with the classical clinical triad of ophthalmoplegia, ataxia, and areflexia. Although the clinical triad is the cardinal diagnostic clue, it can also present with a variety of other atypical neurological symptoms and signs beyond the classical triad. IgG anti-GQ1b antibodies are a powerful serological marker for the diagnosis of MFS, however, they can be absent in 10-15% cases of MFS. Here, we are describing a case of a 55-year old lady with an anti-ganglioside negative case of MFS with ptosis and bulbar palsy, who improved with IVIg.

2021 ◽  
Author(s):  
Vinicius Aldo Cury ◽  
Bruna Pereira Correia ◽  
Leonardo Valente de Camargo ◽  
Juliana Passos ◽  
Gustavo Mafei Fores ◽  
...  

Background: Infection with SARS-CoV-2 can cause COVID-19, which mainly affects the respiratory system. However, neurological complications are frequent, including the group of acquired immune-mediated demyelinating neuropathies (NDAI), including Miller-Fisher syndrome (SMF), characterized by the triad of ophthalmoparesis, ataxia and areflexia. Infection with C. jejuni is the main precipitant of NDAI, but viruses are also related. Objectives: This report aims to describe a case of SMF with concomitant SARS-CoV-2 infection, seen at a tertiary hospital in Northern Paraná and to compare it with the literature. Design and setting: case report of a patient at the hospital neurology service of the Evangelical Hospital, Londrina, Paraná, Brazil. Methods: Report a case of SMF right after confirmation of COVID-19 seen at a tertiary hospital in Northern Paraná and compare it with the literature. Results: Male, 70 years old, white, evolved with progressive and symmetrical crural paraparesis 17 days after confirmation of COVID-19. Upon admission, he presented ataxia, paraesthesia, and crural myotactic areflexia with no signs of pyramidal release, and a score on the Medical Research Council (MRC) muscle strength scale of 58 points. Analysis of CSF with albumin-cytological dissociation. Treatment was performed with intravenous human immunoglobulin (IVIG) and discharged after six days of hospitalization with partial symptomatic improvement. We compared this case with those described in the published literature. Not found Brazilian case published to date. Conclusion: Rare case report of SMF by SARS-CoV-2. The relationship has consistency, temporality, biological plausibility, coherence and analogy compatible with the current literature. Studies with a higher level of evidence are needed to determine the strength of such an association.


2021 ◽  
Vol 11 (2) ◽  
pp. 56-60
Author(s):  
V. A. Malko ◽  
P. V. Klimov ◽  
M. P. Topuzova ◽  
I.  V. Yarush ◽  
K. V. Simakov ◽  
...  

Miller Fisher syndrome is one of the forms of Guillain–Barrе́ syndrome, characterized by a clinical triad that includes ophthalmoplegia, ataxia and areflexia, with the possible addition of moderate peripheral tetraparesis. During the year that has passed since the start of the pandemic of the new coronavirus infection COVID‑19, international publications have presented a few cases of Miller Fisher syndrome, which developed in patients at different times after the COVID‑19 infection – from 3–5 days to 3 weeks. The article presents a description of a clinical case of Miller Fisher syndrome, which occurred with 34‑year‑old man 21 days after the COVID‑19 infection. The clinical manifestations of Miller Fisher syndrome were typical and included diplopia, areflexia, and ataxia. At the beginning of the disease, there was a transient episode of speech impairment in the form of mild dysarthria. Oculomotor disorders predominated in the clinical picture over other components of the classical triad. On the background of treatment with human immunoglobulin G, there was a complete regression of symptoms.This description of Miller Fisher syndrome, which developed after the postponed infection with COVID‑19, is the first in Russia. The presented case demonstrates the ability of the SARS‑CoV‑2 virus to induce the development of an autoimmune disease. Practitioners should take into account the possibility of Miller Fisher syndrome developing in the event of an acute onset of diplopia, ataxia and areflexia in patients after a previous COVID‑19 infection.


Author(s):  
A. Peral Quirós ◽  
F. Acebrón ◽  
M. del Carmen Blanco Valero ◽  
F. Labella Álvarez

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Theocharis Papanikolaou ◽  
Cath Gray ◽  
Bernard Boothman ◽  
Gerald Naylor ◽  
George Mariatos

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.


2021 ◽  
Vol 75 (3) ◽  
pp. 234
Author(s):  
Maja Ravlic ◽  
Lana Knezevic ◽  
Iva Krolo ◽  
Jelena Herman

2018 ◽  
Vol 58 (5) ◽  
pp. 746-749
Author(s):  
David Moreno-Ajona ◽  
Pablo Irimia ◽  
Marta Fernández-Matarrubia

2020 ◽  
Vol 13 (8) ◽  
pp. e236419 ◽  
Author(s):  
Amanda Ray

Beyond the typical respiratory symptoms and fever associated with severe acute respiratory syndrome, we may still have much to learn about other manifestations of the novel SARS-CoV-2 infection. A patient presented with Guillain-Barré syndrome in China with a concurrent SARS-CoV-2 infection. The following case report looks at a patient presenting with the rare Miller Fisher syndrome, a variant of Guillain-Barré while also testing positive for COVID-19.


2019 ◽  
Vol 48 (3) ◽  
pp. 030006051986749
Author(s):  
Yu-Ming Liu ◽  
Yan-Li Chen ◽  
Yan-Hua Deng ◽  
Yan-Ling Liang ◽  
Wei Li ◽  
...  

Miller Fisher syndrome (MFS), a variant of Guillain–Barré syndrome, is characterized by ataxia, areflexia and ophthalmoplegia. This case report describes a 40-year old male that presented with a 3-day history of unsteady walking and numbness on both hands, and a 2-day history of seeing double images and unclear articulation. Lumbar puncture revealed an opening pressure of 260 mm H2O. Plasma serology was positive for anti-ganglioside M1-immunoglobulin M (anti-GM1-IgM) antibodies and negative for anti-ganglioside Q1b (anti-GQ1b) antibodies. The patient was diagnosed with MFS based on the clinical course and neurophysiological findings. On the 4th day of treatment with intravenous immunoglobulin (IVIG), his ataxia and unsteady walking improved, but his bilateral eyeballs were fixed, and over the next few days he developed bilateral peripheral facial paralysis. After 5 days of IVIG treatment, methylprednisolone treatment was offered and the patient's symptoms gradually improved. Early intracranial hypertension and delayed facial nerve palsy may be atypical presentations of MFS. Anti-GM1-IgM antibodies may be the causative antibodies for MFS. If the IVIG therapy does not stop the progression of the disease, the addition of corticosteroid therapy may be effective. However, the relationship between IgM type, anti-GM1 antibody and MFS remains unclear and requires further research.


2012 ◽  
Vol 29 (6) ◽  
pp. 105-110 ◽  
Author(s):  
Seung Min Lee ◽  
Young Seung Ji ◽  
Chang Woo Lee ◽  
Ju Hyun Jeon ◽  
Jung Ho Kim ◽  
...  

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