Miller Fisher syndrome classically presents with ophthalmoplegia, ataxia and areflexia. The syndrome may present rarely with atypical clinical features. Whether the central or peripheral nervous system is primarily involved remains controversial. [ncbi.nlm.nih.gov]

• Intermittent Fever

  In the month preceding admission, he had had low grade, intermittent fevers, followed by a nonproductive cough and sneezing. During hospital admission he lost deep tendon reflexes and was unable to walk. [ncbi.nlm.nih.gov]

• Sneezing

  In the month preceding admission, he had had low grade, intermittent fevers, followed by a nonproductive cough and sneezing. During hospital admission he lost deep tendon reflexes and was unable to walk. [ncbi.nlm.nih.gov]

• Angioedema

  During the course of hospitalization, the patient also developed angioedema. CONCLUSIONS We describe a possible association between Miller Fisher Syndrome, thromboembolic disease, and angioedema. [ncbi.nlm.nih.gov]

  Lin W. 2018 13 MRI findings of optic pathway involvement in Miller Fisher syndrome in 3 pediatric patients and a review of the literature. ( 28209311 ) Malhotra A....Makhani N. 2017 14 A Case of Miller Fisher Syndrome, Thromboembolic Disease, and Angioedema [malacards.org]

• Acroparesthesia

  The authors describe a 38-year-old man who presented with hypernasality, perioral and acroparesthesia, dyspnea, and dysphagia. Further evaluation revealed a diagnosis of Miller-Fisher syndrome (MFS). [ncbi.nlm.nih.gov]

• Otalgia

  In a 48-year-old male tiredness, tinnitus, otalgia, parietal hyperaesthesia, coughing, plugged nose, hypoacusis, globus sensation, epipharyngeal pain, dysarthria, hypogeusia, arthralgia, lid cloni, facial hypaesthesia and tooth ache consecutively developed [ncbi.nlm.nih.gov]

• Tinnitus

  In a 48-year-old male tiredness, tinnitus, otalgia, parietal hyperaesthesia, coughing, plugged nose, hypoacusis, globus sensation, epipharyngeal pain, dysarthria, hypogeusia, arthralgia, lid cloni, facial hypaesthesia and tooth ache consecutively developed [ncbi.nlm.nih.gov]

• Ataxia

  Initially he presented with partial ophthalmoplegia, ataxia. Second episode was characterized by full-blown presentation characterized by ataxia, areflexia and ophthalmoplegia. CSF analysis was typical during both episodes. [ncbi.nlm.nih.gov]

• Headache

  We report a 35-year-old man with anti-GQ(1b) antibody-confirmed Miller Fisher syndrome presenting with severe and persistent headache, and we propose that the headache is caused by antibody-mediated effects on the trigeminovascular pain pathway. [ncbi.nlm.nih.gov]

  […] our case does not enable us to consider diving a predisposing factor, we do think that it could facilitate and probably cause other associated symptoms (headache) that were unclear upon initial diagnosis. [elsevier.es]

  Early symptoms include fever, headache, and pneumonia. They are followed by facial paralysis, diplopia, external ophthalmoplegia, and paresthesia of the arms and trunk. Reported in male patients between 38 and 65 years of age. [whonamedit.com]

• Nystagmus

  However, nystagmus is rare and vertigo, a symptom of vestibulocerebellar dysfunction, has not been reported yet. A 56-year-old woman visited our hospital due to sudden vertigo. [jkna.org]

  Physical examination showed restricted eye movement without nystagmus, bilateral flattening of forehead and nasolabial folds, and positive eyelash sign. Her tongue deviated to the left when protruded. [ncbi.nlm.nih.gov]

  On examination, there was ophthalmoplegia, nystagmus, areflexia and lower limb and gait ataxia. Serological testing was positive for GQ1b antibody in keeping with the diagnosis of Miller Fisher Syndrome (MFS). [eprints.whiterose.ac.uk]

  Several reports document nystagmus, including gaze-evoked (6, 10, 14) dissociated abducting (6, 10, 13), convergence-retraction (10), rebound (13) and upbeat lid nystagmus (15). [neuroophthalmology.ca]

  Negative Steroids/ azathioprine Gradual recovery over 1 year Shin et al.[8] 56 years/male Infliximab Rheumatoid arthritis 10 infusions Ataxia, nystagmus 1:100 Steroids/ IVIG Independent ambulation at 6 months Ratnarajan et al.[10] 43 years/female Infliximab [nnjournal.net]

• Cerebellar Ataxia

  This case indicates that cerebellar ataxia with GAD-Ab can present with acute neurological findings mimicking MFS, and that steroid therapy has an excellent therapeutic effect. [ncbi.nlm.nih.gov]

  Patients typically present with the triad of ophthalmoplegia (external, sparing the pupillary reflexes), cerebellar ataxia and arreflexia. [docneuro.com]

  Rarely is the cerebellar ataxia or areflexia severe enough to cause major problems; the major impediment to these patients is their vision. [accessanesthesiology.mhmedical.com]

  GD1b IgG antibody may be associated with acute motor and sensory axonal neuropathy with cerebellar ataxia or ataxic presentations of Guillain-Barré Syndrome. GQ1b IgG antibody is associated with the Miller-Fisher Syndrome. [questdiagnostics.com]

  Ataxia Associated with Anti-glutamic Acid Decarboxylase Antibodies Mimicking Miller Fisher Syndrome. ( 29093402 ) Nakamura Y....Kimura F. 2018 10 Miller-Fisher Syndrome With Botulism Toxin Ingestion: The Ultimate Descending Paralysis. ( 29465619 ) Hargis [malacards.org]

• Giddiness

  She developed giddiness, diplopia, and limb numbness of acute onset, worsening over 3 days. A history of upper respiratory infection 1 week before admission was elicited. [dx.doi.org]

The patient exhibited the classic triad of ataxia, areflexia, and opthalmoplegia characteristic of MFS, but also had less typical signs and symptoms making for a more challenging diagnostic workup. [ncbi.nlm.nih.gov]

However, other neurological signs and symptoms may also be present leading to a more challenging diagnostic workup. Bilateral ophthalmoplegia is the first presenting feature of MFS. [cureus.com]

The workup suggested a diagnosis of acute polyradiculoneuropathy; thus, the patient was treated with five sessions of plasmapheresis, leading to stabilization of the clinical features and subsequent slow mild clinical improvement, especially of limb ataxia [frontiersin.org]

• Hyperviscosity

  Cerebral infarction following intravenous immunoglobulin is thought to be secondary to hyperviscosity, thromboemboli, vasculitis, or cerebral vasospasm and reported to occur after a short latency when the immunoglobulin load is highest. [ncbi.nlm.nih.gov]

We here report a case of MFS/Bickerstaff brain stem encephalitis (BBE)-overlap syndrome and nonhypertensive PRES that occurred in close temporal association with IVIG treatment and caused stroke. Immunoadsorption ameliorated the disease course. [ncbi.nlm.nih.gov]

Treatment Treatment for Miller Fisher syndrome is identical to treatment for Guillain-Barré syndrome: intravenous immunoglobulin (IVIg) or plasmapheresis (a procedure in which antibodies are removed from the blood) and supportive care. [ninds.nih.gov]

Clinical spectrum, natural history, prognosis, and pathogenesis of MFS are not fully documented. OBJECTIVE: Probe the clinical features of MFS in a tertiary center in Thailand and compare its pattern with other Asian countries. [ncbi.nlm.nih.gov]

Relapses may occur rarely (in less than 3 percent of cases). x Prognosis The prognosis for most individuals with Miller Fisher syndrome is good. [ninds.nih.gov]

Campylobacter jejuni and Haemophilus influenzae are frequently reported etiological agents. We describe a boy with Miller Fisher syndrome following Epstein-002DBarr virus primary infectious mononucleosis. [ncbi.nlm.nih.gov]

While ophthalmoparesis could be compatible with MG, other clinical features suggested a different etiology. [frontiersin.org]

Probably a viral etiology. Precipitating factors of the Miller Fisher syndrome are an upper respiratory tract infection in the majority of cases but also include infection, surgery, vaccination, or insect bite. [accessanesthesiology.mhmedical.com]

Etiology MFS is an autoimmune-mediated peripheral neuropathy associated with anti-GQ1b neuronal antibodies (up to 80% of cases).[1][2] As with Guillain-Barré syndrome, MFS can develop after infection by various pathogens. [eyewiki.aao.org]

Etiology MFS is an autoimmune-mediated peripheral neuropathy associated with anti-GQ1b neuronal antibodies (up to 80% of cases).1 ,2 As with Guillain-Barré syndrome, MFS can develop after infection by various pathogens. [eyewiki.org]

Clinical and epidemiological features of Guillain–Barre syndrome. J Infect Dis 1997; 176 (Suppl. 2): S92–S98. 2. Fisher CM. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia, areflexia). [nature.com]

MFS Epidemiology and Differential Diagnosis Miller Fisher syndrome is a rare disease. The incidence is not precisely known and might vary between geographical areas. [disabled-world.com]

Emilia-Romagna Study Group on Clinical and Epidemiological Problems in Neurology: Guillain-Barré syndrome variants in Emilia-Romagna, Italy, 1992–3: incidence, clinical features, and prognosis. J Neurol Neurosurg Psychiatry 1998;65:218–224. [karger.com]

Clinical and epidemiologic features of Guillain-Barré syndrome. J Infect Dis. 1997 Dec. 176 Suppl 2:S92-8. [Medline]. Walgaard C, Lingsma HF, Ruts L, Drenthen J, van Koningsveld R, Garssen MJ, et al. [medscape.com]

Immunohistochemical studies suggest a pathophysiological role for anti-GQ1b antibodies at the paranodal regions of the oculomotor nerves, at some neurons of the dorsal root ganglia (DRG) and at motor nerve terminals. [ncbi.nlm.nih.gov]

Fisher syndrome (MFS) is the result of a predominantly axonal or demyelinating polyneuropathy and whether the Guillain-Barré syndrome variant of acute ataxia and areflexia without ophthalmoplegia, ataxic Guillain-Barré syndrome (atxGBS), has a distinct pathophysiology [einstein.pure.elsevier.com]

Although it may present as benign as an acute change in voice, early diagnosis and prompt management may prevent further complications. [ncbi.nlm.nih.gov]

Guillain-Barré syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). [jamanetwork.com]

Plasmapheresis and/or administration of intravenous immunoglobulin (IVIg) are the main treatment options, and they aim to reduce the immune reaction and prevent further damage. » Plasmapheresis is a technique where blood is collected; the plasma is isolated [buzzle.com]

How can Guillain-Barré syndrome be prevented? There are no known preventative measures for GBS. What is the evidence? Hughes, RA, Cornblath, DR. “Guillan-Barré syndrome”. Lancet. vol. 366. 2005. pp. 1653-66. [cancertherapyadvisor.com]