Article 4 A Case Presentation of a Third-Nerve Palsy as a Characteristic of Miller Fisher Syndrome

Background: A rare clinical variant of Guillain-Barre syndrome, known as Miller Fisher syndrome (MFS), is an immunemediated neuropathy classically characterized by a triad consisting of ophthalmoplegia, ataxia, and areflexia.1,2 Although MFS is thought to be a disease of immunological basis, other pathological entities may give rise to the syndrome as well. The diagnosis of MFS relies upon clinical signs, a combination of lab tests including antibody serum, cerebrospinal fluid, and electrophysiological findings. Understanding the clinical course of MFS and its ocular components can aid in the rehabilitation and co-management of these patients. Case Report: A 79-year-old white male presented with a four day onset of double vision and an inability to walk unassisted. An examination revealed a pupil-sparing third-nerve palsy with a left eye ptosis. Due to the patient being in moderate pain throughout his entire body and presenting with an acute onset of symptoms, the patient was sent to the emergency room in the same hospital building. The patient was immediately admitted for evaluation and testing which revealed the diagnosis of MFS. Conclusions: Although a complaint of diplopia can lead to an array of diagnoses, when accompanied by an acute inability to walk, MFS should be on the list of possible causes. Although mostly a self-limiting disease, there is the possibility of progressing to respiratory failure. Knowledge of the syndrome, its clinical course, and prognosis, along with an appropriate evaluation with current laboratory testing, will lead to the proper diagnosis, treatment, and management.