November 25, 2006

Miller-Fisher Syndrome

Miller-Fisher Syndrome Miller-Fisher Syndrome is considered a variant of Guillain-Barre Syndrome. It is characterized by ophthalmoplegia, ataxia, and areflexia.

As a resident I was called to see a 2-year-old with the rapid onset of ptosis. At least this is how it was described by the outside doctor. He also noted that the child had difficulty walking. With this information, he considered myasthenia.

The child had a upper respiratory infection 4-5 days prior to presenting. Otherwise he was in good health. The night before he presented, the mother noted that he had very wide eyes. In the morning the child had drooping eyes and difficulty walking. With these symptoms the mother brought him to the outside hospital.

On exam, the child's eyes were very wide with slowly drooping eyelids. Once the eyes were closed they snapped back open. His eyes were always in a midline position. Pupils were reactive. With testing, the child was unable to move his eyes horizontally and upward gaze also seemed impaired. His gait was markedly unsteady. He appeared as if he were aboard a ship. His strength, as much as can be tested in a 2-year-old, seemed normal. Reflexes were absent.

Clinically, this is a case of MFS. An LP and GQ1b antibodies will be obtained to make the definitive diagnosis. The LP should show albuminocytologic dissociation If the patient's condition worsens, plasma exchange or IVIG can be given, but the condition is considered benign, and usually completely resolves.

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