J Korean Ophthalmol Soc.  2017 Feb;58(2):197-202. 10.3341/jkos.2017.58.2.197.

The Characteristics and Prognosis of Miller Fisher Syndrome

• Jung JW
• Lee JH
• Jung JH

• KMID: 2369468
• DOI: http://doi.org/10.3341/jkos.2017.58.2.197

Abstract

PURPOSE
In the present study, the clinical characteristics and prognosis of patients clinically diagnosed with classic Miller Fisher syndrome were evaluated.
METHODS
We retrospectively investigated the clinical and laboratory findings as well as treatment outcomes using the medical records of patients diagnosed with Miller Fisher syndrome. Symptom triad including acute ophthalmoplegia, ataxia, and areflexia were evaluated.
RESULTS
This study included 10 patients. Nine patients had antecedent infectious illness which took an average of 11 ± 9.7 days for onset of diplopia from antecedent infectious systemic illness. Seven patients showed bilateral paralytic strabismus. Specifically, 5 patients showed the involvement of vertical and horizontal extraocular muscles. Pupil impairment and blepharoptosis were observed in 4 patients, limb weakness in 3 patients, dysarthria in 3 patients and facial palsy in 1 patient. Two patients showed contrast enhancement of the abducens nerve on brain magnetic resonance imaging (MRI) and 2 patients showed albumin-cell dissociation on cerebrospinal fluid (CSF) analysis. Eight patients had anti-GQ1b antibodies in their blood serum analysis. Six patients were treated with intravenous immunoglobulins and the other patients were observed with regular follow-ups. The duration of diplopia was 2.9 ± 1.2 months in the treatment group and 3.1 ± 1.7 months in the control group (p > 0.05). The duration of ataxia was 1 ± 0.4 months in the treatment group and 1 ± 0.9 months in the control group (p > 0.05).
CONCLUSIONS
Miller Fisher syndrome should be considered in patients with antecedent infection; acute ophthalmoplegia, ataxia and areflexia as well as anti-GQ1b antibody can be helpful for diagnosis. Final outcomes in the treated group were not significantly different from the control group and all patients showed good final outcomes.

Keyword

Anti-GQ1b; Bickerstaff's brain stem encephalitis; Miller Fisher syndrome; Ophthalmoplegia

MeSH Terms

Abducens Nerve
Antibodies
Ataxia
Blepharoptosis
Brain
Cerebrospinal Fluid
Diagnosis
Diplopia
Dysarthria
Extremities
Facial Paralysis
Follow-Up Studies
Humans
Immunoglobulins, Intravenous
Magnetic Resonance Imaging
Medical Records
Miller Fisher Syndrome*
Muscles
Ophthalmoplegia
Prognosis*
Pupil
Retrospective Studies
Serum
Strabismus
Antibodies
Immunoglobulins, Intravenous

Figure

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  Figure 1. Case 7. Contrast enhancement of the left sixth cra-nial nerve in orbit magnetic resonance image (white arrow).

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