SHM Converge Scientific Abstract ePoster Gallery-A Rare Case Presentation of Miller Fisher Syndrome

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This case report describes a rare presentation of Miller Fisher Syndrome (MFS), a very uncommon variant of Guillain-Barré syndrome (GBS). GBS has an overall incidence of about 1 in 100,000, while MFS is estimated at about 1 in 1,000,000. MFS is classically defined by the triad of ophthalmoplegia, areflexia, and ataxia.<br /><br />The patient was a 63-year-old man with hyperlipidemia and type 2 diabetes who developed diplopia, lower-extremity weakness, numbness, and paresthesia three days after a mild viral illness. An initial hospital evaluation was unrevealing, with negative workup for stroke, demyelination, thyroid disease, vitamin B12 deficiency, syphilis, and acetylcholine receptor abnormalities. Four days later, he returned with worsening weakness, a fall, urinary incontinence, and new hand sensory loss. Examination showed markedly reduced patellar and Achilles reflexes and a mild left fourth cranial nerve palsy causing diplopia. Lumbar puncture showed elevated CSF protein, supporting the diagnosis.<br /><br />Based on ascending weakness, ophthalmoplegia, and areflexia, clinicians diagnosed GBS with the MFS variant. He was initially treated with IVIG at the outside hospital, but due to continued progression, treatment was changed to plasmapheresis. He improved and was discharged to inpatient rehabilitation because of deconditioning.<br /><br />The report emphasizes that MFS is primarily a clinical diagnosis and should be considered early when patients present with eye movement abnormalities and gait or limb weakness after infection. Prompt recognition is important to avoid delayed treatment, prolonged recovery, and significant deconditioning.

Asset Subtitle

Sparsh Jain

Meta Tag

Author List Abrahim N. Razzak, Allison E. Whorton, Pinky Jha, Sparsh Jain

Category Clinical Vignettes

Concept Miller Fisher syndrome

Concept Ophthalmoplegia

Concept Areflexia

Concept Ataxia

Concept Guillain-Barré Syndrome

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Sparsh Jain

Track Adult

Keywords

Miller Fisher Syndrome

Guillain-Barré syndrome

ophthalmoplegia

areflexia

ataxia

diplopia

plasmapheresis

IVIG

elevated CSF protein

post-viral weakness

Miller Fisher syndrome

Ophthalmoplegia

Areflexia

Ataxia

Guillain-Barré Syndrome