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Miller Fisher syndrome: a diagnosis not to be missed

  • S J Davis (a1), R Salib (a1), H Buchan (a2) and E Nilssen (a1)


We report a case of Miller Fisher syndrome presenting in an ENT setting. The referral was made on the basis of worsening nasal regurgitation following Campylobacter jejuni enteritis. The aim of this report is not to add to the recorded instances of Miller Fisher syndrome, but to help raise the level of its awareness amongst otolaryngologists. Emphasis is placed on the mode of presentation and management issues, as early diagnosis is crucial and confers a favourable prognosis. In that respect, we consider this case noteworthy and instructive.


Corresponding author

Address for correspondence: Mr S J Davis, 106 Nibley Road, Shirehampton, Bristol BS11 9XW, UK. Fax: 0117 9595850 E-mail:


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1Fisher, CM. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). N Engl J Med 1956;255:5765
2Overell, JR, Willison, HJ. Recent developments in Miller Fisher syndrome and related disorders. Curr Opin Neurol 2005;18:562–6
3Ito, M, Odaka, M, Koga, M, Hirata, K, Yuki, N. Clinical features and treatment of Fisher syndrome [in Japanese]. Rinsho Shinkeigaku 2005;45:514–17
4Chiba, A, Kusunoki, S, Obata, H, Machinami, R, Kanazawa, I. Ganglioside composition of the human cranial nerves, with special reference to pathophysiology of Miller Fisher syndrome. Brain Res 1997;745:32–6
5Yuki, N, Taki, T, Takahashi, M, Saito, K, Yoshino, H, Tai, T et al. Molecular mimicry between GQ1b, ganglioside and lipopolysaccharides of Campylobacter jejuni isolated from patients with Fisher's syndrome. Ann Neurol 1994;36:791–3
6Koga, M, Gilbert, M, Li, J, Koike, S, Takahashi, M, Furukawa, K et al. Antecedent infections in Fisher syndrome: a common pathogenesis of molecular mimicry. Neurology 2005;64:1605–11
7Goodyear, CS, O'Hanlon, GM, Plomp, JJ, Wagner, ER, Morrison, I, Veitch, J et al. Monoclonal antibodies raised against Guillain-Barré syndrome-associated Campylobacter jejuni lipopolysaccharides react with neuronal gangliosides and paralyze muscle-nerve preparations. J Clin Invest 1999;104:697708
8Halstead, SK, O'Hanlon, GM, Humphreys, PD, Morrison, DB, Morgan, BP, Todd, AJ et al. Anti-disialoside antibodies kill perisynaptic Schwann cells and damage motor nerve terminals via membrane attack complex in a murine model of neuropathy. Brain 2004;127:2109–23
9O'Hanlon, GM, Plomp, JJ, Chakrabarti, M, Morrison, I, Wagner, ER, Goodyear, CS et al. Anti-GQ1b ganglioside antibodies mediate complement-dependent destruction of the motor nerve terminal. Brain 2001;124:893906
10Hughes, RA, Cornblath, DR. Guilain-Barre syndrome. Lancet 2005;366:1653–66
11Meythaler, JM. Rehabilitation of Guillain-Barré syndrome. Arch Phys Med Rehabil 1997;78:872–9
12Guiloff, RJ. Peripheral nerve conduction in Miller Fisher syndrome. J Neurol Neurosurg Psychiatry 1977;40:801–7
13Fross, RD, Daube, J. Neuropathy in the Miller-Fisher syndrome: clinical and electrophysiologic findings. Neurology 1987;37:1493–8
14Battaglia, F. Recurrent Miller-Fisher syndrome. Rev Neurol (Paris) 2005;161:844–7
15The Guillain-Barré Syndrome Study Group. Plasmapheresis and acute Guillain-Barré syndrome. Neurology 1985;35:1096–104
16McKhann, GM, Griffin, JW, Cornblath, DR, Mellits, ED, Fisher, RS, Quaskey, SA. Plasmapheresis and Guillain-Barré syndrome: analysis of prognostic factors and the effect of plasmapheresis. Ann Neurol 1988;23:347–53
17French Cooperative Group on plasma exchange in Guillain-Barré syndrome. Appropriate number of plasma exchanges in Guillain-Barré syndrome. Ann Neurol 1997;41:298306
18Espérou, H, Jars Guincestre, MC, Bolgert, F, Raphael, JC, Durand-Zaleski, I, French Cooperative Group on plasma exchange in Guillain-Barré syndrome. Cost-effectiveness of plasma exchange therapy for the treatment of Guillain-Barré syndrome. Intensive Care Med 2000;26:1094–100
19Hughes, RA, Raphael, C, Swan, AV, van Doom, PA. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev 2001;2:CD002063
20Hughes, RAC, Wijdicks, E, Barohn, RJ. Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2003;61:736–40
21Dalakas, MC. Intravenous immunoglobulin in autoimmune neuromuscular diseases. JAMA 2004;291:2367–75
22Korinthenberg, R, Schessl, J, Kirschner, J, Montning, JS. Intravenous immunoglobulin in the treatment of childhood Guillain-Barré syndrome. Pediatrics 2005;116:226–8
23Farcas, P, Avnun, L, Herishanu, YO, Wirguin, I. Efficacy of repeated intravenous immunoglobulin in severe unresponsive Guillain-Barré syndrome. Lancet 1997;350:1747
24Willison, HJ, Townson, K, Veitch, J, Boffrey, J, Issacs, N, Andersen, SM et al. Synthetic disialylgalactose immunoadsorbents deplete anti-GQ1b antibodies from autoimmune neuropathy sera. Brain 2004;127:680–91
25Hughes, RAC, van der Meche, FG. Corticosteroids for treating Guillain-Barré syndrome. Cochrane Database Syst Rev 2000;2:CD001446
26Rich, MM, Pinter, MJ, Craner, SD, Barchi, RL. Loss of electrical excitability in an animal model of acute quadriplegic myopathy. Ann Neurol 1998;43:171–9
27Pritchard, J, Gray, IA, Idrissova, ZR, Lecky, BR, Sutton, IJ, Swan, AV et al. A randomized controlled trial of recombinant interferon-beta 1a in Guillain-Barré syndrome. Neurology 2003;61:1282–4
28Bechtold, DA, Yue, X, Evans, RM, Davies, M, Gregson, NA, Smith, KJ. Axonal protection in experimental autoimmune neuritis by the sodium channel blocking agent flecainide. Brain 2005;128:1828
29Merkies, IS, Schmitz, PI, Samijn, JP, van der Meché, FG, van Doom, PA. Fatigue in immune-mediated polyneuropathies. European Inflammatory Neuropathy Cause and Treatment (INCAT) Group. Neurology 1999;53:1648–54
30Bernsen, AJAM, De Jager, AEJ, Schmitz, PIM, van der Meché, FGA. Long-term impact on work and private life after Guillain-Barré syndrome. J Neurol Sci 2002;201:1317
31Bickerstaff, ER, Cloake, PC. Mesencephalitis and rhombencephalitis. BMJ 1951;2:7781
32Odaka, M, Yuki, N, Yamada, M, Koga, M, Tagemi, T, Hirata, K et al. Bickerstaff's brainstem encephalitis: clinical features of 62 cases and a subgroup associated with Guillain-Barre syndrome. Brain 2003;126:2279–90


Miller Fisher syndrome: a diagnosis not to be missed

  • S J Davis (a1), R Salib (a1), H Buchan (a2) and E Nilssen (a1)


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