Miller-Fisher Syndrome.

Main Article Content

Suntaree Thitiwichienlert
Wimolwan Tangpagasit


Background: The Guillain-Barré syndrome (GBS) is an acute idiopathic polyneuritis, it has several variants. Miller-Fisher syndrome (MFS) is an uncommon variant of GBS and is characterized by a triad of acute ophthalmoplegia, ataxia, and areflexia. The difference between common variants of GBS and MFS is that GBS exhibits limb weakness, whereas in MFS the limb weakness is absent.

Case Report: We present a 60-year-old male complaining of bilateral progressive ptosis and gait ataxia. Eye examinations revealed bilateral ptosis and complete total ophthalmoplegia. Neurological examinations revealed normal deep tendon reflexes and no motor or sensory deficits. MRI brain and orbit demonstrated normal cavernous sinuses and brainstem. Lumbar puncture revealed albuminocytological dissociation. The diagnosis was confirmed by a serum test showing anti-GQ1b antibody seropositivity.

Conclusion: MFS is uncommon and may be frequently misdiagnosed as brainstem stroke or myasthenia gravis. Neurological examinations are of clinical importance. MFS must be considered in the differential diagnosis in patients presenting with bilateral total ophthalmoplegia and ataxia or areflexia.

Conflict of interest: none.


Download data is not yet available.

Article Details

Case Report


1. Fisher CM, An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia) N Eng J Med. 1956l255:57-65.
2. Hiraga A, Mori M, Ogawara K, Hattori T, Kuwabara S. Differences in patterns of progression in demyelinating and axonal Gullain-Barre syndromes. Neurology. 2003;61(4):471–474.
3. Esposito S, Longo MR. Guillain-Barré syndrome. Autoimmune Rev. 2017;16(1):96-101.
4. Dimachkie MM, Barohn RJ. Guillain-Barré syndrome and variants. Neuro Clin. 2013;31(2):491-510.
5. Hafer-Macko C, Sheikh KA, Li CY, Ho TW, Cornblath DR, McKhann GM, Asbury AK, Griffin JW. Immune attack on the Schwann cell surface in acute inflammatory demyelinating polyneuropathy. Ann Neurol. 1996;39(5):625-35.
6. McGrogan A, Madle GC, Seaman HE, de Vries CS. The epidemiology of Guillain-Barré syndrome worldwide. A systematic literature review. Neuroepidemiology. 2009;32(2):150-163.
7. Hughes RA, Rees JH. Clinical and epidemiologic features of Guillain-Barré syndrome. J Infect Dis. 1997 Dec 176 Suppl 2:S92-8.

8. Walgarrd C, Lingsma HF, Ruts L, Drenthen J, van Korningsveld R, Garssen MJ, et al. Prediction of respiratory insufficiency in Guillain-Barré syndrome. Ann Neurol.2010;67(6):781-7.
9. Grygorczuk S, Zajkowska J, Kondrusik M, Pancewicz S, Hermanowska-Szpakowicz T. [Guillain-Barré Syndrome and its association with infectious factors]. Neurol Neurochir Pol. 2005;39(3):230-6.
10. Gullain G. Les polyradiculonévrites avec dissociation albuminocytologique et á evolution favorable (syndrome de Guillain et Barré) [French] J. Belge Neurol. Psychiatr. 1938;38:323-9.
11. Van der Merché FG, Van Doorn PA, Meulstee J,Jennekens FG; GBS-consensus group of the Dutch Neuromuscular Research Sipport Centre. Diagnostic and classification criteria for the Guillain-Barré syndrome. Eur. Neurol. 2001;45(3):133-9.
12. Nair AG, Patil-Chhablani P, Venkatramani DV, Gandhi RA. Ocular myasthenia gravis: a review. Indian J Ophthalmol. 2014;62(10):985-91.
13. McFarland R, Taylor RW, Turnbull DM. A neurological perspective on mitochondrial disease. Lancet Neurol. Aug 2010;9(8):829-840.
14. Umapathi T, Tan E, Kokubun N, Verma K, Yuki N. Non-demyelinating , reversible conduction failure in Fisher syndrome and related disorders. J Neurol. Neurosurg. Psychiatry 2012;83:941-8.
15. Willison HJ. Ganglioside complexes as targets for antibodies in Miller Fisher syndrome. J Neurol Neurosurg Psychiatry. 2006;77:1002–3.
16. Shahrizalia N, Yuki N. Bickersatff brainstem encephalitis and Fisher syndrome: anti-GQ1b antibody syndrome. J. Neurol. Neurosurg. Psychiatry. 2013;84:576-83.
17. Hughes RA, Wijdicks EF, Benson E, Cornblath DR, Hahn AF, Meythaler JM, et al. Supportive care for patients with Guillain-Barré syndrome: Multidisciplinary Consensus Group. Arch Neurol. 2005;62:1194–8.
18. Hughes RA, Swan AV, van Korningsveld R, van Doorn PA. Corticosteroids for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2006 Apr 19(2):CD001446.
19. Mori M, Kuwabara S, Fukutake T, Hattori T. Intravenous immunoglobulin therapy for Miller Fisher syndrome. Neurology. 2007;68:1144–6.