Miller Fisher Syndrome - Ophthalmoplegia and Hyperreflexia

Update Item Information
Identifier MFS_with_HYPER_DTR-Gold
Title Miller Fisher Syndrome - Ophthalmoplegia and Hyperreflexia
Alternative Title Video 4.29 Miller Fisher syndrome (MFS) causing ophthalmoparesis, sluggish pupils and imbalance from Neuro-Ophthalmology and Neuro-Otology Textbook
Creator Daniel R. Gold, DO
Affiliation (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
Subject Range of Eye Movements/Motility Abnormal; Horizontal Gaze Palsy; Miller Fisher Syndrome
Description 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
Date 2016
Language eng
Format video/mp4
Type Image/MovingImage
Collection Neuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s62v64d2
File Name MFS_with_HYPER_DTR-Gold.mp4
Setname ehsl_novel_gold
ID 1209840
Reference URL https://collections.lib.utah.edu/ark:/87278/s62v64d2
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