Miller Fisher syndrome with bilateral vocal cord paralysis: a case report

Miller Fisher syndrome is a variant of acute inflammatory demyelinating polyneuropathy classically characterized by ataxia, ophthalmoplegia, and areflexia. Miller Fisher syndrome can present with uncommon symptoms such as bulbar, facial, and somatic muscle palsies and micturition disturbance. We des...

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Bibliographic Details
Published in:Journal of medical case reports 2020-02, Vol.14 (1), p.31-31, Article 31
Main Authors: Ramakrishna, Karan N, Tambe, Vikrant, Kattamanchi, Adithya, Dhamoon, Amit S
Format: Article
Language:English
Subjects:
Acute flaccid paralysis
Ataxia
Autoimmune demyelinating polyneuropathy
Blood
Botulism
Case Report
Case reports
Drug dosages
Electrolytes
Encephalitis
Hepatitis
Hospitalization
Metabolism
Ostomy
Paralysis
Pneumonia
Respiratory failure
Stroke
Urine
Ventilators
Vitamin deficiency
Vocal cord palsy
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Summary:Miller Fisher syndrome is a variant of acute inflammatory demyelinating polyneuropathy classically characterized by ataxia, ophthalmoplegia, and areflexia. Miller Fisher syndrome can present with uncommon symptoms such as bulbar, facial, and somatic muscle palsies and micturition disturbance. We describe the case of a 76-year-old white man with new-onset ataxia, stridor, areflexia, and upper and lower extremity weakness who required intubation at presentation. An initial work-up including imaging studies and serum tests was inconclusive. Eventually, neurophysiological testing and cerebrospinal fluid analysis suggested a diagnosis of Miller Fisher syndrome. Our patient responded to treatment with intravenous immunoglobulin and supportive therapy. The occurrence of acute or subacute descending paralysis with involvement of bulbar muscles and respiratory failure can often divert clinicians to a diagnosis of neuromuscular junction disorders (such as botulism or myasthenia gravis), vascular causes like stroke, or electrolyte and metabolic abnormalities. Early identification of Miller Fisher syndrome with appropriate testing is essential to prompt treatment and prevention of further, potentially fatal, deterioration.
ISSN:1752-1947
1752-1947
DOI:10.1186/s13256-020-2357-4