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.

Intravenous immunoglobulin therapy for Miller Fisher syndrome

Neurology ◽  
2007 ◽  
Vol 68 (14) ◽  
pp. 1144-1146 ◽  
Author(s):  
M. Mori ◽  
S. Kuwabara ◽  
T. Fukutake ◽  
T. Hattori
Keyword(s):  
Intravenous Immunoglobulin ◽  
Immunoglobulin Therapy ◽  
Miller Fisher Syndrome ◽  
Intravenous Immunoglobulin Therapy ◽  
Fisher Syndrome

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.

High dose immunoglobulin therapy is effective in the Miller Fisher syndrome

1993 ◽  
Vol 241 (3) ◽  
pp. 178-179 ◽  
Author(s):  
U. Zifko ◽  
M. Drlicek ◽  
G. Senautka ◽  
W. Grisold
Keyword(s):  
Immunoglobulin Therapy ◽  
Miller Fisher Syndrome ◽  
High Dose ◽  
Fisher Syndrome

scholarly journals Syndrome of Inappropriate Secretion of Antidiuretic Hormone due to Selective Serotonin Reuptake Inhibitors After Pancreaticoduodenectomy for Carcinoma of the Ampulla of Vater: Case Report

2013 ◽  
Vol 98 (4) ◽  
pp. 289-291
Author(s):  
Ryota Iwase ◽  
Hiroaki Shiba ◽  
Takeshi Gocho ◽  
Yasuro Futagawa ◽  
Shigeki Wakiyama ◽  
...  
Keyword(s):  
Antidiuretic Hormone ◽  
Serum Sodium ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Plasma Osmolality ◽  
Sodium Concentration ◽  
Ampulla Of Vater ◽  
Serum Sodium Concentration ◽  
Selective Serotonin ◽  
Inappropriate Secretion

Abstract A 68-year-old man underwent pancreaticoduodenectomy with lymph nodes dissection for carcinoma of the ampulla of Vater. The patient had anxiety neurosis and had been treated with a selective serotonin reuptake inhibitor (SSRI). Postoperatively, SSRI was resumed on postoperative day 2. His serum sodium concentration gradually decreased, and the patient was given a sodium supplement. However, 11 days after the operation, laboratory findings included serum sodium concentration of 117 mEq/L, serum vasopressin of 2.0 pg/mL, plasma osmolality of 238 mOsm/kg, urine osmolality of 645 mOsm/kg, urine sodium concentration of 66 mEq/L, serum creatinine concentration of 0.54 mg/dL, and serum cortisol concentration of 29.1 μg/dL. With a diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH), the antianxiety neurosis medication was changed from the SSRI to another type of drug. After switching the medication, the patient made a satisfactory recovery with normalization of serum sodium by postoperative day 20.

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.

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