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Abstract Details

Normal CSF and EMG Findings in a Patient with Miller Fisher Syndrome
Autoimmune Neurology
P1 - Poster Session 1 (12:00 PM-1:00 PM)
038
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A 30-year-old male presented to the emergency department with ataxic gait, double vision, and tingling in his extremities that began 11 days after an upper respiratory infection. His physical examination revealed ophthalmoplegia, dysmetria, reduced sensation to light touch, temperature, and vibration in his distal extremities, and an unsteady gait with a positive Romberg sign. Despite unremarkable MRI scans of his orbits, brain, and spine, and normal EMG and lumbar puncture results, elevated serum Ganglioside GQ1b antibodies with a titer of 1:128000 confirmed a diagnosis of Guillain-Barré syndrome, Miller Fisher variant. The patient underwent five days of IVIG treatment, showing gradual symptom improvement, and reported near-complete resolution one week post-discharge.

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Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS), accounting for 5-10% of cases in the US and Europe, with a slightly higher incidence in males. It usually follows a gastrointestinal or upper respiratory infection and is characterized by symptoms such as ophthalmoplegia, areflexia, and ataxia, appearing within a few days to a week. Unlike typical GBS, which primarily affects limb strength, MFS impacts cranial nerves and ocular muscles due to antibodies against GQ1b ganglioside, a component of oculomotor nerve myelin. This leads to demyelination. Cerebrospinal fluid analysis often shows albuminocytologic dissociation in about 90% of patients. Electrodiagnostic tests in MFS typically show reduced or absent sensory responses but normal sensory conduction velocities. However, in some rare cases, like in the described patient, these tests may yield no abnormalities.
Authors/Disclosures
Nazanin Kiapour, MD
PRESENTER
Dr. Kiapour has nothing to disclose.
Mariah Siddiqui, MD Dr. Siddiqui has nothing to disclose.
Reuben Brathwaite, MD (Neuroscience Institute) Dr. Brathwaite has nothing to disclose.
Anuradha Singh, DO (Hackensack Meridian Health Network) Dr. Singh has nothing to disclose.