Elijah Salzer, DMSc, PA-C, NYSAFE, C-EFM
Miller Fisher syndrome (MFS) often presents in an atypical manner, other than its traditionally described three symptoms of ataxia, areflexia, and ophthalmoplegia. MFS is an acute immune-mediated polyneuropathy that is classified as a sub-variant of Guillain Barre` syndrome (GBS). This is a case of a 62 y.o. male who was diagnosed with Miller Fisher syndrome after he presented to the ED twice with advancing atypical neurologic symptoms before the diagnosis was made. Initially presenting with paresthesia, unsteady gait, and speech changes the patient underwent extensive work-up and was discharged with an unclear etiology. He returned with worsening symptoms including hyperesthesia, hyporeflexia, ptosis, positional dysphonia, and sensory ataxia. Cerebral Spinal Fluid (CSF) studies showed elevated proteins and he was treated with intravenous Immunoglobulin (IVIG) for 4 days, with near complete resolution of symptoms on 6-month follow-up. The article discusses current literature, consisting mostly of case studies, describing the varied presenting symptoms, common diagnostic studies, and treatments. No randomized control trials have been completed regarding therapy and it is possible the condition is self-limiting. However, due to GBS and its variants with crossover presentations IVIG remains the most common treatment.
Nelson JL. Miller Fisher Syndrome: An Atypical Case Presentation of Ataxia, Hyporeflexia, Dysesthesia, and Positional Dysphonia. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2022; 4(4).
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