Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2010:2010:291840.
doi: 10.1155/2010/291840. Epub 2010 Sep 1.

Acute bilateral ophthalmoparesis with pupilary areflexical mydriasis in miller-fisher syndrome treated with intravenous immunoglobulin

Theocharis Papanikolaou  1 , Cath Gray, Bernard Boothman, Gerald Naylor, George Mariatos
Affiliations
Case Reports

Acute bilateral ophthalmoparesis with pupilary areflexical mydriasis in miller-fisher syndrome treated with intravenous immunoglobulin

Theocharis Papanikolaou et al. J Ophthalmol. 2010.

Abstract

Miller-Fisher syndrome (MFS) is a rare condition characterized by the classical triad of ophthalmoplegia, ataxia, and areflexia (Fisher, 1956). It is considered a variant of Guillain-Barré syndrome (GBS) with which it may overlap, or it can occur in more limited forms. We report a case of a thirty-five-year-old male who presented with a six-day history of diplopia, following a recent chest infection. On examination, he was found to have bilateral sixth nerve palsy, bilateral fourth nerve palsy, bilateral areflexical mydriasis, ataxia and total absence of reflexes. After excluding other conditions, a diagnosis of Miller-Fisher syndrome was made. The patient was administered intravenous immunoglobulin and made an uneventful recovery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Bilaterally dilated pupils with absent response to light when light is shown to the left eye.
Figure 2
Figure 2
Bilaterally dilated pupils with absent response to light when light is shown to the right eye.
Figure 3
Figure 3
Absent pupil response to accommodation of both eyes and normal convergence.
Figure 4
Figure 4
Right esotropia.
Figure 5
Figure 5
Left esotropia.
Figure 6
Figure 6
Underaction of left eye on laevoversion.
Figure 7
Figure 7
Full abduction of left eye on ductions.
Figure 8
Figure 8
Underaction of right eye on dextroversion.
Figure 9
Figure 9
Full abduction of right eye on ductions.
Figure 10
Figure 10
Hess chart showing bilateral fourth and sixth nerve palsy.
See this image and copyright information in PMC

References

    1. Fisher M. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia) The New England Journal of Medicine. 1956;255(2):57–65. - PubMed
    1. Willison HJ, O’Hanlon GM. The immunopathogenesis of Miller Fisher syndrome. Journal of Neuroimmunology. 1999;100(1-2):3–12. - PubMed
    1. Yuki N. Molecular mimicry between gangliosides and lipopolysaccharides of Campylobacter jejuni isolated from patients with Guillain-Barré syndrome and Miller Fisher syndrome. The Journal of Infectious Diseases. 1997;176(6):S150–S153. - PubMed
    1. Chiba A, Kusunoki S, Shimizu T, Kanazawa I. Serum IgG antibody to ganglioside GQ1b is a possible marker of Miller Fisher syndrome. Annals of Neurology. 1992;31(6):677–679. - PubMed
    1. Van der Meché FGA, Van Doorn PA, Meulstee J, Jennekens FGI. Diagnostic and classification criteria for the Guillain-Barré syndrome. European Neurology. 2001;45(3):133–139. - PubMed

Publication types

LinkOut - more resources