scholarly journals Atypical Miller Fisher Syndrome with Anisocoria and Rapidly Fluctuating Pupillary Diameter

2015 ◽  
Vol 2015 ◽  
pp. 1-2 ◽  
Author(s):  
Garima Gupta ◽  
Antonio Liu
Keyword(s):  
Case Reports ◽  
Gastrointestinal Symptoms ◽  
Serum Levels ◽  
Miller Fisher Syndrome ◽  
Pupillary Diameter ◽  
Fisher Syndrome ◽  
Upper Respiratory Infection ◽  
Upper Respiratory ◽  
Atypical Presentations ◽  
Intravenous Steroids

Miller Fisher syndrome is a variant of Guillain-Barre syndrome characterized by the classic triad of ophthalmoplegia, ataxia, and areflexia. Pupillary involvement is common in MFS and has been reported in 35–42% of MFS patients. Although case reports have discussed isolated ophthalmoplegia as a presentation of MFS, anisocoria and rapid fluctuation of pupillary diameter have not been reported in anti-GQ1b antibody positive individuals. Here we describe an individual who presented with diplopia and was found to have progressive internal and external ophthalmoplegia with frequent fluctuations in pupillary diameter and anisocoria. These exam findings are not commonly described even in atypical presentations of MFS. The onset of symptoms was preceded by an upper respiratory infection but no gastrointestinal symptoms. Imaging and CSF studies were unremarkable; however serum levels of immunoglobulin G anti-GQ1b antibody and anti-GAD antibody were elevated confirming the diagnosis of MFS. The patient was treated with IVIG and intravenous steroids with mild resolution of external ophthalmoplegia. He did not go on to develop more typical features of MFS such as ataxia or areflexia. This demonstrates that isolated external and internal ophthalmoparesis with rapidly fluctuating pupillary diameter and associated anisocoria can be the sole manifestation of atypical MFS.

scholarly journals A Case of Miller-Fisher Syndrome with Syndrome of Inappropriate Secretion of Antidiuretic Hormone

2021 ◽  
pp. 380-383
Author(s):  
Shunya Fujiwara ◽  
Yasuhiro Manabe ◽  
Yumiko Nakano ◽  
Yoshio Omote ◽  
Hisashi Narai ◽  
...  
Keyword(s):  
Antidiuretic Hormone ◽  
Immunoglobulin Therapy ◽  
Sodium Concentration ◽  
Miller Fisher Syndrome ◽  
Intravenous Immunoglobulin Therapy ◽  
Fisher Syndrome ◽  
Upper Respiratory Infection ◽  
Inappropriate Secretion ◽  
Unsteady Gait ◽  
Upper Respiratory

We report a 72-year-old woman with Miller-Fisher syndrome (MFS) with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). She developed diplopia and unsteady gait a week after an upper respiratory infection. Neurologic examination revealed ophthalmoplegia, ataxia, symmetrical weakness, numbness, and areflexia. She underwent intravenous immunoglobulin therapy. Her serum sodium concentration decreased to 119 mEq/L on day 12. She had low plasma osmolarity (254 mosm/kg), high urine osmolarity (457 mosm/kg), and high urine sodium level (73 mEq/L), while the blood level of antidiuretic hormone was normal. Anti-GD1b immunoglobulin G (IgG), -GQ1b IgG, -GT1a IgG, and -Gal-C IgM antibodies were positive. We diagnosed her with MFS overlapping with SIADH. Four weeks after onset, her symptoms recovered. The elevation of anti-GD1b, -GQ1b, and -GT1a antibodies that recognize disialosyl residue may be pathologically related to SIADH.

Bilateral vocal cord paralysis in Miller Fisher syndrome/Guillain-Barre overlap syndrome and a review of previous case series

2021 ◽  
Vol 14 (1) ◽  
pp. e240386
Author(s):  
Jeeyune Bahk ◽  
Wanding Yang ◽  
Jonathan Fishman
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Case Reports ◽  
Case Series ◽  
Overlap Syndrome ◽  
Miller Fisher Syndrome ◽  
Bilateral Vocal Cord Paralysis ◽  
Fisher Syndrome ◽  
Rare Manifestation ◽  
Guillain Barré

Miller Fisher syndrome (MFS), an acute demyelinating neuropathy, is characterised by a triad of areflexia, ataxia and ophthalmoplegia. It is the most common variant of Guillain-Barre Syndrome (GBS). In about 5.6%–7.1% of MFS cases, patients also suffer from progressive motor weakness of the limbs. This condition is termed MFS/GBS overlap syndrome. Whether it is in MFS or GBS, bilateral vocal cord paralysis (BVCP) is a rare manifestation with limited cases reported in the literature. We report an extremely rare case where a 65-year-old man developed BVCP in an MFS/GBS overlap syndrome. We have also reviewed previous case reports in the literature for comparison.

scholarly journals Atypical Variant of Guillain Barre Syndrome in a Patient with COVID-19

2020 ◽  
Vol 6 (4) ◽  
pp. 231-236
Author(s):  
Megan M. Lowery ◽  
Muhammad Taimur Malik ◽  
Joseph Seemiller ◽  
Cynthia S. Tsai
Keyword(s):  
Respiratory Failure ◽  
Clinical Symptoms ◽  
Neurological Symptoms ◽  
Miller Fisher Syndrome ◽  
Guillain Barre Syndrome ◽  
Nasopharyngeal Swab ◽  
Fisher Syndrome ◽  
Upper Respiratory Infection ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

AbstractObjectiveA rare variant Miller Fisher Syndrome overlap with Guillain Barre Syndrome is described in an adult patient with SARS-COV-2 infection.Case PresentationThe clinical course of a 45-year-old immunosuppressed man is summarized as a patient who developed ataxia, ophthalmoplegia, and areflexia after upper respiratory infection symptoms began. A nasopharyngeal swab was positive for COVID-19 polymerase chain reaction. He progressed to acute hypoxemic and hypercapnic respiratory failure requiring intubation and rapidly developed tetraparesis. Magnetic resonance imaging of the spine was consistent with Guillain Barre Syndrome. However, the clinical symptoms, along with positive anti-GQ1B antibodies, were consistent with Miller Fisher Syndrome and Guillain Barre Syndrome overlap. The patient required tracheostomy and had limited improvement in his significant neurological symptoms after several months.ConclusionsThe case demonstrates the severe neurological implications, prolonged recovery and implications in the concomitant respiratory failure of COVID-19 patients with neurological symptoms on the spectrum of disorders of Guillain Barre Syndrome.

scholarly journals Miller-Fisher Syndrome: Two Case Reports

2015 ◽  
pp. 137-139
Author(s):  
Selcen Yaroğlu Kazancı ◽  
Gülseren Arslan
Keyword(s):  
Case Reports ◽  
Miller Fisher Syndrome ◽  
Fisher Syndrome

Atypical Manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children: A Review

2021 ◽  
Vol 17 ◽  
Author(s):  
Sofia Βenou ◽  
Shamez Ladhani ◽  
Gabriel Dimitriou ◽  
Despoina Gkentzi
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Case Series ◽  
Upper Respiratory Infection ◽  
Mild Disease ◽  
Atypical Manifestations ◽  
Novel Coronavirus ◽  
Atypical Presentations

Background: In December 2019, a local outbreak of pneumonia presented in Wuhan (China), and quickly identified to be caused by a novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The disease caused by SARS-CoV-2 was named COVID-19 and was soon declared as pandemic because of the millions of infections and thousands of deaths worldwide. Children infected with SARS-CoV-2 usually develop asymptomatic or mild disease compared to adults. They are also more likely to have atypical and non-specific clinical manifestations than adults. Methods: A literature search was performed in PubMed and Scopus to summarize the extrapulmonary manifestations of SARS-CoV-2 infection in children since the beginning of the pandemic. Peer-reviewed papers in English were retrieved using the following keywords and combinations: ‘pediatric’, ‘child’, ‘infant’, ‘neonate’, ‘novel coronavirus’, ‘SARS-CoV-2’, ‘COVID 19’ and ‘gastrointestinal’, ‘renal’, ‘cardiac’, ‘dermatologic’ or ‘ophthalmologic’. We included published case series and case reports providing clinical symptoms and signs in SARS-CoV2 pediatric patients. Results: Although fever and symptoms of upper respiratory infection are the most frequently presented, a variety of other atypical presentations has also been reported. The clinical spectrum includes dermatological, ophthalmological, neurological, cardiovascular, renal, reproductive, and gastrointestinal presentations. In addition, a rare multi-inflammatory syndrome associated with SARS-CoV-2 infection has been reported in children, often leading to shock requiring inotropic support and mechanical ventilation. Conclusions: Clinicians need to be aware of the wider range of extrapulmonary atypical manifestations of SARS-CoV-2 infection in children, so that appropriate testing, treatment, and public health measures can be implemented rapidly.

scholarly journals ГУМОРАЛЬНИЙ ІМУНІТЕТ У ДІТЕЙ ШКІЛЬНОГО ВІКУ ЗІ ПОЗАШПИТАЛЬНОЮ ПНЕВМОНІЄЮ

World Science ◽  
2018 ◽  
Vol 2 (8(36)) ◽  
pp. 8-10
Author(s):  
Бабік І. В.
Keyword(s):  
Immunoglobulin A ◽  
Serum Levels ◽  
Secretory Immunoglobulin A ◽  
Pathogenic Microorganisms ◽  
First Line ◽  
Upper Respiratory Infection ◽  
Immune Systems ◽  
Potential Risk Factors ◽  
Upper Respiratory ◽  
Secretory Immunoglobulin

Secretory immunoglobulin A (sIgA) is often characterized as a component of the immune systems “first-line of defense” against pathogenic microorganisms, viruses, and bacteria. A lower concentration of sIgA in saliva has been conceptualized as a risk factor for upper respiratory infection in children. Also, individual differences in sIgA levels in response to infection have been identified as potential risk factors. No gender differences in SIgA levels have been reported. sIgA in saliva is not directly related to serum levels of sIgA.

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