Bilateral ophthalmoplegia and areflexia in miller fisher syndrome (a variant of GBS) a case report /
Edgardo D.C. Tiglao Jr.
- Fairview, Quezon City Department of Medicine, FEU-NRMF, 2010
- (in folder)
Includes appendices and bibliographical references.
ABSTRACT: Miller Fisher Syndrome as a variant of Guillain Barre Syndrome is a triad of total external ophthalmoplegia, gait ataxia and loss of tendon reflexes. Majority of patients had acute infectious process weeks prior to the disease. Several lines of evidence support an autoimmune basis where both cellular and humoral immune mechanisms contribute to the tissue damage. Diagnosis rests mostly on characteristics clinical manifestations. CSF, and electrophysiologic findings. MFS is described as a benign condition, and is usually treated with immunoglobulins and plasmapheresis. This is a case of N.B., 57 years old, female, with no known history of previous respiratory and gastrointestinal infection presented as bilateral ophthalmoplegia. She also manifested with bilateral ptosis and hyporeflexia progressing to areflexia. Initial impression upon admission was to consider Brain Stem Infraction vs. Demyelinating disease. Diagnostic done were Cranial MRI with contrast and DWI showed suspicious enhancing lesion in the left cavernous sinus/area of the superior orbital fissure, CSF examination revealed albumino- cytologic dissociation, EMG-NCV of the Limbs and Eyelids showed findings that do not absolutely rule out a GBS variant such as Miller Fisher Syndrome. She underwent plasmapheresis for treatment and eventually recovered.