Eyes wide open—an atypical presentation of Miller Fisher syndrome (MFS): case report

Abstract Background Parinaud’s syndrome, also known as dorsal midbrain is characterized by a combination of signs, including upgaze palsy, convergence–retraction nystagmus, eyelid retraction and pupillary dissociation. It caused pretectal or tegmental lesions upper brainstem. Miller Fisher the triad ataxia, areflexia ophthalmoplegia, has rarely been reported to present syndrome in adults. To our knowledge, this clinical manifestation not previously described children. Case presentation A healthy 13-year-old girl presented with blurred vision diplopia, 10 days after viral infection. Initial examination revealed incomplete while rest neurological was normal. Brain imaging (MRI, MRA) did reveal any abnormal findings CSF were During first admission she gradually deteriorated, showing complete external unsteady gait, absent deep tendon reflexes lower limbs normal muscle power. With suspicion IVIG administered, leading subsequent resolution her symptoms. AntiGQ1b antiGD1b antibodies came back positive confirming diagnosis. On 1 month follow-up, diplopia left gaze, second dose administered good response. She remains asymptomatic year from disease onset. Conclusions can Herein we pediatric patient similar presentation. As typical semiology ataxia may be initially, high index required recognise treat those patients promptly. Serological detection anti-ganglioside antibodies, such anti-GQ1b anti-GD1b, help confirm