J Clin Neurol.
2021 Oct;17(4):541-545. 10.3988/jcn.2021.17.4.541.
Miller Fisher Syndrome in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Systematic Review
- Martins-Filho PR
1 - de Andrade ALP1
- de Andrade AJP1
- Moura da Silva MD1
- Souza Araújo AAd2
- Nunes PS2
- Santos VS3
- Ferreira LC4
- Aquino Neves ELd5
- Quintans-Júnior LJ6
- Affiliations
-
- 1Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Brazil
- 2Laboratory of Pharmaceutical Assays and Toxicity, Federal University of Sergipe, São Cristóvão, Brazil.
- 3Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil.
- 4Neuroimmunology Clinic, Federal University of Sergipe, Aracaju, Brazil.
- 5Division of Neurology, Department of Medicine, Federal University of Sergipe, Aracaju, Brazil.
- 6Laboratory of Neuroscience and Pharmacological Assays, Federal University of Sergipe, São Cristóvão, Brazil
- KMID: 2520417
- DOI: http://doi.org/10.3988/jcn.2021.17.4.541
Abstract
- Background and Purpose
Miller Fisher syndrome (MFS) is a subtype of Guillain-Barré syndrome characterized by the triad of ophthalmoparesis, areflexia, and ataxia. Although cases of MFS have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, no studies have synthesized the clinical characteristics of patients with this condition.
Methods
In this rapid systematic review, we searched the PubMed database to identify studies on MFS associated with SARS-CoV-2 infection.
Results
This review identified 11 cases, of whom 3 were hospitalized with motor and/or sensory polyneuropathy as the first sign of SARS-CoV-2 infection. SARS-CoV-2 RNA was not detected in analyses of cerebrospinal fluid, suggesting a mechanism of immune-mediated injury rather than direct viral neurotropism. However, antiganglioside antibodies were found in only two of the nine patients tested. It is possible that target antigens other than gangliosides are involved in MFS associated with SARS-CoV-2 infection.
Conclusions
The present patients exhibited clinical improvement after being treated with intravenous immunoglobulin. Although rare, patients with SARS-CoV-2 infection may present neurological symptoms suggestive of MFS. Early recognition of the MFS clinical triad is essential for the timely initiation of treatment.
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