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A case of Miller Fisher syndrome: atypical findings and therapeutic considerations
A Appiotti1, G Scarzella, F Trebini
1Divisione Neurologica, Ospedale Mauriziano Umberto I, Torino.
Abstract:
The Miller Fisher syndrome (MFS) is generally considered to be a disease of the peripheral nervous system. In some cases contemporary involvement of the central nervous system has been described (CNS). We report a case in which it was possible to prove involvement of cranial nerves VII, VIII, IX and X and to exclude CNS involvement. We discuss the possible role of early plasmapheresis treatment on disease evolution.
Insights
Miller Fisher syndrome (MFS) typically affects the peripheral nervous system. This case study confirms cranial nerve involvement while excluding central nervous system (CNS) disease, exploring early treatment impacts.
Area of Science:
- Neurology
- Neuroimmunology
- Peripheral Nervous System Disorders
Background:
- Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome.
- It is characterized by ophthalmoplegia, ataxia, and areflexia.
- While primarily affecting the peripheral nervous system, central nervous system (CNS) involvement has been occasionally reported.
Observation:
- This report details a specific MFS case with confirmed involvement of cranial nerves VII, VIII, IX, and X.
- Diagnostic investigations successfully ruled out concurrent central nervous system (CNS) pathology.
- The clinical course and potential influence of early plasmapheresis were closely monitored.
Findings:
- Cranial nerve palsies (VII, VIII, IX, X) were definitively identified in this MFS patient.
- Evidence strongly supported peripheral nervous system (PNS) disease exclusively, with no signs of CNS demyelination or inflammation.
- The patient's response to early plasmapheresis was observed in relation to disease progression.
Implications:
- This case reinforces the understanding of MFS as a distinct peripheral neuropathy.
- It highlights the importance of thorough neurological examination to differentiate PNS from CNS involvement in MFS.
- The findings prompt further investigation into the efficacy of early plasmapheresis in modulating MFS outcomes.