SHM Converge Scientific Abstract ePoster Gallery-Unmasking Miller Fisher: A Young Man Turns the Tide

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This case report describes a 41-year-old man who initially presented with left arm weakness, hoarseness, and pharyngeal discomfort. His initial neurologic evaluation suggested a possible MRI-negative stroke, as CT and MRI imaging were unrevealing and his NIHSS score was 4. However, within hours his condition worsened significantly, developing bilateral leg weakness, ophthalmoplegia, breathing difficulty, and ataxia, prompting ICU admission.<br /><br />Laboratory studies, including CBC, CMP, and perfusion markers, were normal. CSF analysis was also atypical for Guillain-Barré syndrome, showing normal opening pressure, normal protein, and no pleocytosis. Despite these non-classic findings, anti-GQ1b antibodies were later positive, confirming Miller Fisher syndrome (MFS), a rare variant of Guillain-Barré syndrome characterized by ophthalmoplegia, ataxia, and areflexia.<br /><br />He was treated promptly with five cycles of plasmapheresis and improved rapidly. After 12 days in the hospital, he was discharged with near-baseline function, with only residual ophthalmoplegia. At one-month follow-up, he was neurologically intact.<br /><br />The report emphasizes that Miller Fisher syndrome may present atypically and can progress quickly, even without the classic CSF albuminocytologic dissociation seen in many GBS cases. Because of overlap with other neurologic disorders such as stroke, clinicians should maintain a high index of suspicion and begin treatment early rather than waiting for confirmatory testing. Early recognition and intervention are critical for favorable outcomes in this potentially life-threatening condition.

Asset Subtitle

Momen Alsayed

Meta Tag

Author List Achol Cyer, Khalid Ibrahim, Momen Alsayed, Nadhem Abdallah, Sagi Elhassan

Category Clinical Vignettes

Concept Miller Fisher syndrome

Concept Guillain-Barré Syndrome

Concept Ophthalmoplegia

Concept Ataxia

Concept Areflexia

Distinguished Non-Finalist

Presenter Organization University of Arizona, Banner University Medical Center Tucson

Presenting Author Momen Alsayed

Track Adult

Keywords

Miller Fisher syndrome

anti-GQ1b antibodies

Guillain-Barré syndrome

ophthalmoplegia

ataxia

areflexia

plasmapheresis

MRI-negative stroke

ICU admission

neurologic weakness

Miller Fisher syndrome

Guillain-Barré Syndrome

Ophthalmoplegia

Ataxia

Areflexia