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Published on: April 14, 2014
Optic neuritis in a patient with Miller-Fisher syndrome
Praween Lolekha1, Kammant Phanthumchinda
1Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Abstract:
Miller-Fisher syndrome (MFS) is considered a variant of Guillain-Barrd syndrome (GBS). The syndrome is characterized by acute onset of gait ataxia, ophthalmoplegia, and areflexia. Conventionally, MFS has been considered exclusively a disease of the peripheral nervous system. However there are occasional reports of central nervous system involvement. Here, a 62 year-old woman who presented with classical features of MFS and progressive bilateral dyschromatopsia and reported visual impairment. Normal MRI of the brain and CSF albumino-cytologic dissociation were observed. CSF oligoclonal IgG pattern indicated a passive transfer of oligoclonal IgG from a systemic inflammatory response. Nerve conduction studies showed slow motor conduction velocity in her extremities. The optic fundi were normal. Visual evoked potentials (VEPs) revealed bilateral optic neuropathy. Marked spontaneous improvement of her syndrome was documented within six weeks. Optic neuritis may be a central nervous system feature that should be recognized as part of the MFS.
Insights
Miller-Fisher syndrome (MFS), a Guillain-Barrd syndrome (GBS) variant, can involve the central nervous system. This case highlights optic neuritis as a potential MFS manifestation, improving spontaneously.
Area of Science:
- Neuroscience
- Immunology
Background:
- Miller-Fisher syndrome (MFS) is a rare variant of Guillain-Barrd syndrome (GBS).
- MFS classically affects the peripheral nervous system, presenting with ataxia, ophthalmoplegia, and areflexia.
- Central nervous system (CNS) involvement in MFS is uncommon but reported.
Observation:
- A 62-year-old woman exhibited typical MFS symptoms alongside progressive dyschromatopsia and visual impairment.
- Brain MRI was normal; CSF showed albumino-cytologic dissociation and a passive IgG transfer pattern.
- Nerve conduction studies revealed slowed motor velocities; VEPs indicated bilateral optic neuropathy.
Findings:
- Despite normal optic fundi, visual evoked potentials confirmed bilateral optic neuropathy.
- CSF oligoclonal IgG patterns suggested a systemic inflammatory response.
- The patient experienced significant spontaneous recovery within six weeks.
Implications:
- Optic neuritis should be considered a potential central nervous system manifestation of Miller-Fisher syndrome.
- This case expands the understanding of MFS pathophysiology and clinical spectrum.
- Recognizing CNS involvement aids in comprehensive diagnosis and management of MFS.
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