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Pupillary Involvement in Miller Fisher Syndrome.

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Miller Fisher Syndrome (MFS) can present with tonic pupils. Raised anti-GQ1b antibody levels aid in diagnosing these atypical MFS cases.

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Internal ophthalmoplegiaMiller Fisher syndromemydriasispupil

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Area of Science:

  • Neurology
  • Immunology

Background:

  • Miller Fisher Syndrome (MFS) is typically defined by ophthalmoplegia, ataxia, and areflexia.
  • Atypical MFS presentations include ophthalmoparesis without the full classical triad.

Observation:

  • This report details two MFS patients exhibiting tonic pupils.
  • Both patients presented with elevated anti-GQ1b antibody titers.

Findings:

  • Bilateral dilated pupils, including tonic or fixed pupils, are a potential MFS manifestation.
  • Anti-GQ1b immunoglobulin G (IgG) antibodies are valuable diagnostic markers for unexplained MFS cases.
  • The ciliary ganglion or short ciliary nerves are hypothesized sites of involvement.

Implications:

  • Recognizing tonic pupils expands the diagnostic spectrum of MFS.
  • Anti-GQ1b IgG testing can confirm MFS in patients with atypical neurological signs.
  • Understanding the specific nerve involvement aids in targeted treatment strategies.