Miller-Fisher Syndrome II

I first talked about this case a few weeks ago (Nov. 25). After being staffed with the attending and undergoing a number of diagnostic tests, some consistent with the diagnosis, others not, the two-year-old is still felt to have Miller-Fisher Syndrome.

Albuminocytologic dissociation was not present. This is only expected within a day or two of onset. The LP was days later.

Abnormal enhancement of the cranial nerves was present on MRI: III, V, and VI.

GQ1b IgG antibody was negative. This is present in 90% of cases. The child never progressed to a syndrome more consistent with Bickerstaff's Brainstem Encephalitis or Guillian-Barre Syndrome. Patients with these two diagnoses can also express GQ1b antibody. No other antibody was tested in the patient.

MFS carries a good prognosis and the child was not treated. There have been no randomized trials but case series show no benefit to either IVIG or Plasma Exchange. After about 5 days in the hospital, the child left in about the same condition as when he arrived.