Miller fisher syndrom abstract miller fisher syndrom is a guillainbarre variety characterized for oftalmoplejia, arreflexia and ataxia. The prognosis for most individuals with miller fisher syndrome is good. Miller fisher syndrome main features are lack of muscle coordination ataxia, eye muscle weakness resulting in the inability to move the eyes in several directions ophthalmoplegia, and the absence of tendon. It causes nerve damage, resulting in a loss of coordination, reflexes, and muscle control. The characteristic symptom of miller fisher syndrome is abnormal muscle coordination where the patients walk becomes clumsy or sloppy. Guillainbarre syndrome gbs is an acute, immunemediated, monophasic illness usually triggered by a preceding infection. Miller fisher syndrome mfs is a rare variant of gbs, observed in only about 1% to 5% of all cases of gbs in western countries. We report a 52yearold patient with miller fisher syndrome and discuss wernickes encephalopathy as one important differential diagnosis. The predominant features of mfs are ophthalmoplegia and ataxia, with a peripheral neuropathy being only a very mild clinical feature.
A case of miller fischer variant of guillain barre syndrome. Miller fisher syndrome radiology reference article. Since then, 223 cases of miller fisher syndrome have been published. Herein, we report a rare case that fits the diagnoses of both mfs and bbe. We present 3 cases studied at the puebla general hospital in one year his treatment and evolution. While gbs affects just 1 person in 100,000, mfs is even. The diagnosis of miller fisher syndrome was performed on the dual basis of clinical features in addition to an investigations report. The main features are lack of muscle coordination ataxia, eye muscle weakness resulting in the inability to move the eyes in several directions ophthalmoplegia, and the absence of tendon reflexes. Miller fisher december 5, 19, waterloo, ontario april 14, 2012, albany, new york was a canadian neurologist whose notable contributions include the first detailed descriptions of lacunar strokes, the identification of transient ischemic attacks as stroke precursors, the identification of the link between carotid atherosclerosis and stroke, and. Miller fisher syndrome symptoms, diagnosis, treatments and.
The best known variant is the sensory ataxic form of miller fisher syndrome, which also affects the oculomotor nerves and the brain stem. They often have an opening in the roof of the mouth cleft palate andor a split in the. The millerfisher syndrome mfs is an acute inflammatory demyelinating polyneuropathy. Miller fisher syndrome mfs is a subgroup of a more common yet still rare nerve disorder known as guillainbarre syndrome gbs. The disease often follows infections with and may be caused by an abnormal immune response to certain pathogens, esp. Miller fisher syndrome mfs, also called fisher s syndrome, usually begins with the rapid development, over days, of 3 problems. Miller syndrome is a rare condition that mainly affects the development of the face and limbs. General information regarding miller fisher syndrome, a postinfectious, immune mediated neuropathy considered to be a variant of guillainbarre syndrome.
Miller fisher syndrome mfs is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia, and is considered a variant form of guillainbarre. Yun wang 1, heyin mi1, hongjun hao2, wenli hu1 1department of neurology, beijing chaoyang hospital, capital medical university, pr china 2department of neurology, first hospital of peking university, pr china abstract millerfisher syndrome mfs is considered to be a variant of guillainbarree syndrome gbs. It is largely a clinical diagnosis based on the cardinal clinical features of ataxia, areflexia, and opthalmoplegia, however, other neurological signs and symptoms may also be present. Botulism mimicking miller fisher syndrome neurology. This disease exhibits a classic clinical triad of ataxia,are. Mfs, also called fishers syndrome, usually begins with the rapid development, over days, of 3 problems.
As miller fisher syndrome is a variant of guillainbarre. Miller fisher syndrome mfs, also called fishers syndrome, usually begins with the rapid development, over days, of 3 problems. Miller fisher syndrome is a mild form of guillainbarre syndrome. What is miller fisher syndromecausessymptomstreatment. Variants and formes frustes may complicate recognition. Robert d sandler, nigel hoggard and marios hadjivassiliou abstract a 50yearold man presented with a brief history of slurred speech, unsteadiness, double vision and paraesthesia. A 48yearold woman was hospitalized due to blurred vision and unsteady gait lasting for 9 days, and numbness of the limbs lasting for 6 days. Pdf miller fisher syndrome is an uncommon disease and it is a variant of guillainbarre syndrome. It is characterized by abnormal muscle coordination, paralysis of the eye muscles, and absence of the tendon reflexes. A man aged 30 years presented to the emergency department ed with ataxia, areflexia, facial weakness, ophthalmoplegia, extremity weakness and back pain for 4 days. This disorder is characterized by distinctive craniofacial malformations that occur in association with limb abnormalities. Gq1b igg antibody has a role in the pathogenesis of the syndrome, especially of ophthalmoplegia.
Children with miller syndrome are born with underdeveloped cheek bones malar hypoplasia and a very small lower jaw micrognathia. Miller fisher syndrome also has rarer variants find. The symptoms may develop over hours to a few weeks. To research the causes of miller fisher syndrome, consider researching the causes of these these diseases that may be similar, or associated with miller fisher syndrome. Pdf miller fisher syndrome mfs is an acute demyelinating polyneuropathy characterized by ophthalmoplegia, ataxia and areflexia. Clinical and electrophysiologic data recorded in patients with fisher syndrome characterized by ophthalmoplegia, ataxia, and areflexia are presented. The initial symptoms are typically changes in sensation or pain along with muscle weakness, beginning in the feet and hands, often spreading to the arms and upper body, with both sides being involved. Standard protocol approvals, registrations, and patient. Approximately 50% of patients, however, also have ptosis, pupillary or other cranial nerve palsy, and 25%. Clinical features and prognosis of miller fisher syndrome. The annual incidence is around one patient per one million population.
The causes of miller fisher syndrome is not completely understood. Miller fisher syndrome mfs, a variant of the guillainbarre syndrome gbs, is characterized by ophthalmoplegia, ataxia, and areflexia. It is considered as autoimmune disease because there are antibodies which attack the nerve cell. The double outline blurring the figures indicates the presence of ataxia. Clinical features and prognosis of miller fisher syndrome neurology. The waddling, ducklike gait is likely due to the loss of a fat rich insulating material called myelin around nerves, designated as 1a, that innervate the major sensory organ of muscle called the muscle spindle. T he annual incidence of miller fisher syndrome is about 0. Md rashedul islam fcps, mrcpuk registrar, neurology, birdem 2. Though the presentation is alarming, it has a benign outcome with complete recovery within weeks. Cases with limb weakness or pleocytosis in the csf were excluded, according to fisher. We report an exceptional case of recurrent mfs and consequent residual disability. Miller fisher syndrome mfs is a variant of guillain. They are now believed to represent, along with a number of other entities, different clinical manifestations of a similar underlying autoimmune disorder, antigq1b igg antibody syndrome.
As in my case, it is characterised by opthalmoplegia, ataxia and areflexia. The prognosis of miller fisher syndrome was goodrecovery occurred after a mean time period of 10. A large amount of protein without cell reaction was found during the third week of illness in. James collier first discovered the variant in 1932 and. The triad of ataxia, areflexia and ophthalmoplegia was first described as a variant of the guillainbarre syndrome in 1932 by collier. Millerfisher, ataxia, magnetic resonance spectroscopy, cerebellum. Miller fisher syndrome mfs is a variant of guillainbarre syndrome gbs, accounting for approximately 5% of acute inflammatory polyneuropathies. Pdf miller fisher syndrome an uncommon clinical presentation. Neurologic problems persist in up to 20 percent of patients with the disease, and onehalf of these patients are severely disabled. Because of the close relation between gbs and mfs, plasmapheresis may prove. Miller fisher syndrome gbscidp foundation international.
Miller fisher syndrome mfs, a clinical variant of gbs, occurs in. Miller fisher syndrome and polyneuritis cranialis in covid19. In most cases, recovery begins within 2 to 4 weeks of the onset of symptoms, and may be. He had been unwell for 12 days with campylobacter gastroenteritis.
Miller fisher syndrome is a rare, acquired nerve disease that is considered to be a variant of guillainbarre syndrome. Large studies have shown that plasmapheresis1 and immunoglobulin treatment2 are beneficial for treating gbs. Bickerstaff brainstem encephalitis bbe and millerfisher syndrome mfs might be a pedigree disease. Miller fisher syndrome causes, symptoms, diagnosis. The severity of this disorder varies among affected individuals. Miller fisher syndrome or, mfs, is a postinfectious, immune mediated neuropathy characterized in typical instances by the clinical triad of ataxia, areflexia and ophthalmoplegia.
781 1598 1417 1331 767 621 92 192 1496 983 1041 1581 915 1033 851 922 1339 762 1196 1284 1582 1620 630 190 546 603 1541 825 1551 403 748 862 148 1341 1603 666 1483 384 1378 1262 820 682