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Involvement of the central nervous system in Miller Fisher syndrome: a case report
F Irsel Tezer1, Gunfer Gurer, Hulya Karatas
1Department of Neurology, Hacettepe University Hospitals, 06100, Ankara, Turkey. firsel@turk.net
Abstract:
Miller Fisher syndrome (MFS) is characterised by ophthalmoplegia, ataxia and areflexia. Reports on cerebellar ataxia and supranuclear oculomotor derangement in MFS suggested an additional involvement of the central nervous system (CNS), resembling Bickerstaff's brainstem encephalitis (BBE). In the present report, a patient with a monophasic acute illness, early recovery and specific clinical-laboratory findings suggested both intrinsic brainstem and peripheral nerve disease (MFS and BBE). In pons and medulla oblangata, blurred to discrete T2-lesions were revealed by cranial MRI, while involvement of peripheral nerves was detected with EMG. The CSF showed no increase in protein or cell content, such as occurs in brainstem encephalitis.
Insights
Miller Fisher syndrome (MFS) and Bickerstaff
Area of Science:
- Neurology
- Neuroimmunology
Background:
- Miller Fisher syndrome (MFS) presents with ophthalmoplegia, ataxia, and areflexia.
- Overlap with Bickerstaff's brainstem encephalitis (BBE) suggests potential central nervous system involvement.
Observation:
- A case study of a patient with acute MFS and BBE-like symptoms.
- Clinical presentation included ophthalmoplegia, ataxia, and areflexia with early recovery.
Findings:
- Cranial MRI revealed T2-lesions in the pons and medulla oblongata.
- Electromyography (EMG) confirmed peripheral nerve involvement.
- Cerebrospinal fluid (CSF) analysis showed normal protein and cell counts, atypical for encephalitis.
Implications:
- This case highlights the co-occurrence of MFS and BBE, indicating shared pathophysiology.
- Findings suggest MFS can involve the central nervous system, presenting as brainstem encephalitis.
- Further research is needed to understand the immunopathogenesis of combined MFS and BBE.
