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One-sided triangle: A case of double vision.

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Miller Fisher syndrome, a Guillain-Barre syndrome variant, can present atypically. This case highlights the importance of considering this diagnosis in patients with bilateral ophthalmoplegia.

Keywords:
Miller Fisher syndromediplopiamydriasisophthalmoplegia

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Area of Science:

  • Neurology
  • Immunology

Background:

  • Guillain-Barre syndrome is an autoimmune disorder affecting the peripheral nervous system.
  • Miller Fisher syndrome (MFS) is a rare variant characterized by ophthalmoplegia, ataxia, and areflexia.

Observation:

  • A 51-year-old woman presented with acute diplopia, ptosis, and complete bilateral external and internal ophthalmoplegia.
  • Her neurological examination revealed normal reflexes and gait.

Findings:

  • Serological testing revealed elevated GQ1b ganglioside autoantibodies.
  • Diagnosis of Miller Fisher syndrome was confirmed based on clinical presentation and serological findings.

Implications:

  • This case demonstrates an atypical MFS presentation without ataxia or areflexia.
  • Clinicians should consider MFS in patients with unexplained bilateral ophthalmoplegia.