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Atypical Miller Fisher syndrome associated with glutamate receptor antibodies

Taku Hatano1, Yoshiaki Shimada, Ayako Kono

  • 1Department of Neurology, Juntendo University, School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan. thatano@juntendo.ac.jp

BMJ Case Reports
|June 19, 2012
PubMed

Insights

This study details a rare Miller Fisher syndrome case with psychosis and involuntary movements. Autoantibodies against glutamate receptors were identified as the cause of these atypical symptoms.

Area of Science:

  • Neuroimmunology
  • Neurology

Background:

  • Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome, typically characterized by ophthalmoplegia, ataxia, and areflexia.
  • Atypical presentations of MFS can overlap with other autoimmune neurological disorders, necessitating comprehensive diagnostic approaches.

Observation:

  • A young woman presented with acute ataxia, areflexia, ophthalmoplegia, psychosis, and involuntary movements (IVMs).
  • Serological testing revealed anti-GQ1b and anti-GT1a antibodies, consistent with MFS.
  • Additionally, autoantibodies against glutamate receptors, including GluRε2 and NMDAR (NR1/NR2), were detected in serum and cerebrospinal fluid.

Findings:

  • The co-occurrence of MFS with psychosis and IVMs suggests an expanded autoimmune phenotype.
  • The presence of anti-glutamate receptor antibodies indicates a potential role for these antibodies in the atypical MFS symptoms.

Implications:

  • This case highlights the importance of considering NMDAR encephalitis-like symptoms in MFS and vice versa.
  • The findings suggest that autoantibodies against various glutamate receptors may contribute to psychosis and IVMs in MFS.
  • Further research is warranted to understand the complex interplay between different autoantibodies in neurological disorders.

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