Miller Fisher Syndrome - Ophthalmoplegia and Hyperreflexia
Range of eye movements/motility abnormal; Horizontal gaze palsy; Miller Fisher Syndrome
Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
This is a 45-yo-woman who presented with mild imbalance and diplopia. There had been a preceding viral illness several weeks prior. Examination demonstrated horizontal gaze paresis (sparing unilateral adduction), mild gait ataxia (no clear appendicular ataxia), and hyperreflexia. Pupils were sluggish OU. Her anti-Gq1b antibodies came back very high and MFS was diagnosed. IVIG was given, and there was gradual improvement (of all symptoms/signs) back to her baseline over 3-6 months. While the typical triad includes ophthalmoplegia, ataxia, and HYPOreflexia, occasionally, HYPERreflexia is seen instead as in our patient. There may also be overlap between MFS and Bickerstaff's brainstem encephalitis - however, our patient had no symptoms or signs (aside from potentially her hyperreflexia) referable to the brainstem. Brain MRI was normal.
Spencer S. Eccles Health Sciences Library, University of Utah