Miller Fisher Syndrome - Ophthalmoplegia and Hyperreflexia

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 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. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This is a 45 year-old 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. https://collections. lib.utah.edu/ark:/87278/s62v64d2