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Case Reports
. 2014 Oct 4;6(3):226-31.
doi: 10.1159/000368183. eCollection 2014 Sep.

A case of neuromyelitis optica masquerading as miller fisher syndrome

Yuka Furutani  1 , Masayuki Hata  1 , Kazuaki Miyamoto  1 , Yusaku Moribata  2 , Nagahisa Yoshimura  1
Affiliations
Case Reports

A case of neuromyelitis optica masquerading as miller fisher syndrome

Yuka Furutani et al. Case Rep Neurol. .

Abstract

A 22-year-old woman presented with double vision that she had experienced since an infection 2 weeks previously. A neurological examination showed limited bilateral eye abduction, mimicking Miller Fisher syndrome. However, T2-weighted magnetic resonance imaging of her brain revealed hyperintense areas in the tegmentum of the pons, including the abducens nucleus, and her serum anti-aquaporin-4 antibody test was positive. She was finally diagnosed with neuromyelitis optica. Intravenous high-dose steroid therapy immediately improved the patient's abduction palsy, but bilateral optic neuritis manifested during the treatment. Subsequent treatment with plasma exchange improved her optic neuritis symptoms.

Keywords: Abduction palsy; Miller Fisher syndrome; Neuromyelitis optica; Optic neuritis.

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Figures

Fig. 1
Fig. 1
a Eye movement test profile showing bilateral abduction deficit with right dominance. At presentation, the patient had esotropia in the primary position. b Axial fluid-attenuated inversion recovery MRI showing hyperintense areas (left panel) in the tegmentum of the pons with right dominance (top left) and the dorsal medulla oblongata including the area postrema (bottom left). No significant changes were noted in the optic nerves (middle panel). A sagittal spinal T2-weighted MRI revealed a longitudinal lesion (right panel).
Fig. 2
Fig. 2
a Images of axial fluid-attenuated inversion recovery MRI after IVMP showing diminishment of the hyperintense lesions (left panel) in the tegmentum of the pons (top left) and the dorsal medulla oblongata including the area postrema (bottom left). A sagittal spinal T2-weighted MRI revealed diminishment of the hyperintense lesions (right panel). b Visual field test scores for the left eye from the Humphrey Field Analyzer 30-2 program, at the onset of optic neuritis (left) and after additional steroid pulse and plasma exchange (right). c Coronal (left panel) and axial (right panel) contrast-enhanced MRI showing swelling and enhancement of the bilateral optic nerves.
See this image and copyright information in PMC

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