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Proceedings SNO “Percorsi clinici in Neuroscienze”

Case report V SESSIONE
“PERCORSI CLINICI COMPLESSI”

Atypical cases of Miller Fisher syndrome:
discussion of two clinical cases

E. FUNELLI*, M. REPACI**, S. ROTA**, D. VALLAURI**, A. GALBUSSERA**, S. BERETTA**

* Università degli Studi di Milano-Bicocca, Italy
** UOC di Neurologia, Ospedale di Vimercate (Monza e Brianza), ASST Brianza, Italy

INTRODUCTION thalmoplegia. The patient didn’t present ataxia and
reflexes were normal. Workup revealed CSF albumi-
Miller-Fisher syndrome is considered a variant of the nocytological dissociation, while anti-GQ1b antibo-
Guillain-Barré syndrome and is characterized by oph- dies were negative. Treatment with intravenous gam-
thalmoplegia, ataxia and areflexia and typically asso- ma globulin was started, followed by steroids admi-
ciated with anti-GQ1b antibodies. In the last decades nistration. Neurological improvement was observed
the recognition of similarities between MF and after two weeks. The patient was dismissed with par-
Bickerstaff brainstem encephalitis, such as peripheral tial recovery and addressed to follow-up. The patient
neuropathy, CSF albuminocytological dissociation fully recovered after a month.
and lastly the presence of anti-GQ1b antibodies, led Case 2. The second case is a 73-year-old male patient
to the definition of “anti-GQ1b Syndrome”: under who presented with imbalance and dizziness a week
this denomination several neurological presentations after flu vaccination, followed two weeks later by on-
(characterized by anti-GQ1b antibodies positivity) set of headache, cognitive slowing and decreased vi-
were included, representing various degrees of exten- sion combined with diplopia. Objective examination
sion of the spectrum, ranging from incomplete and revealed almost complete external ophthalmoplegia,
atypical forms to overlap and extended forms. nystagmus and absence of deep tendon reflexes, but
However, it is known that a significant percentage of no ataxia. CFS total proteins were not as much eleva-
patients (> 10%) are seronegative for anti-GQ1b an- ted as expected and nerve conduction studies showed
tibodies in both MFV and BBE, and recently different no signs of poliradicoloneuritis. No specific therapy
studies documented the existence of many types of has been administered and patient showed complete
related auto-antibodies. spontaneous recovery. Anti-GQ1b antibodies were po-
sitive, and patient was diagnosed with incomplete MF.

CASE REPORTS
DISCUSSION
Here we report two cases of atypical presentations.
Case 1. The first is a 63-year-old male patient who These cases demonstrate the challenges related to the
presented with progressive unilateral external oph- diagnosis and the recognition of the various degrees

Corrispondenza: Dr. Eugenio Funelli, UOC di Neurologia, Ospedale, via Santi Cosma e Damiano 10, 20871 Vimercate (MB), e-mail:
Vimercate, e-mail: e.funelli@campus.unimib.it
Percorsi clinici in Neuroscienze. Clinical Round SIN e SNO Lombardia, 21 gennaio 2022, Desio (Monza e Brianza)
Atti a cura di Paolo Ferroli, Alessandra Protti, Andrea Salmaggi, Ignazio Michele Santilli, Luca Valvassori
Copyright © 2022 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-135-2

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