A Challenging Case of Miller Fisher Syndrome: The Importance of Clinical Recognition

Abstract

Guillain-Barré syndrome (GBS) is an immune-mediated
polyradiculoneuropathy with several forms of presentation
being the sensory-motor the most frequent. Miller Fisher
syndrome (MFS) is a rare variant of GBS that is characterized by ophthalmoplegia, decreased osteotendinous reflexes and ataxia. We describe a twenty-five-years-old young man with subacute double vision, difficulty articulating words, muscle weakness and altered sensitivity. On neurological examination, he presented limitation of binocular abduction, peripheral facial dysparesis, dysphonia, dysarthria, dysphagia, decreased cervical strength, proximal-distal tetraparesis, hypo-reflexia and axial ataxia. Complementary diagnostic tests showed results within normal limits. He underwent five days of intravenous human Immunoglobulin and functional rehabilitation program, with excellent therapeutic
response and progressive improvement of neurological
deficits. In short, the clinical overlap between variants of GBS is a reality and, therefore, the early establishment of
the diagnosis and its therapeutic orientation are of vital importance in the prognosis of patients.