Miller Fisher syndrome mimicking Wer-nicke encephalopathy during pregnancy

Jung Hwa Seo; Mi-Ri Kang; Byeol-A Yoon; Ki-Hwan Ji; Seong-il Oh

doi:10.14253/acn.2019.21.1.53

Journal List > Ann Clin Neurophysiol > v.21(1) > 1121232

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Seo, Kang, Yoon, Ji, and Oh: Miller Fisher syndrome mimicking Wer-nicke encephalopathy during pregnancy

Case Report

Ann Clin Neurophysiol 2019;21(1):53-56.

Published online: 20 January 2019

DOI: https://doi.org/10.14253/acn.2019.21.1.53

Miller Fisher syndrome mimicking Wer-nicke encephalopathy during pregnancy

Jung Hwa Seo¹, Mi-Ri Kang¹, Byeol-A Yoon², Ki-Hwan Ji¹, Seong-il Oh^1,

¹Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

²Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea

Correspondence to Seong-il Oh Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: +82-51-890-6130 Fax: +82-51-892–8811 E-mail: seongil.oh@gmail.com

Received 12 June 2018 Revised 13 October 2018 Accepted 23 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Miller Fisher syndrome (MFS) is characterized by ataxia, areflexia, and ophthalmoparesis. Here we present a case of MFS mimicking Wernicke encephalopathy (WE) during pregnancy. A 31-year-old woman at 8 weeks of gestation presented with diplopia and ataxia after experi-encing nausea and vomiting for several weeks. We initiated thiamine based on a suspicion of WE, which produced no clear effects. However, her symptoms began to improve following intravenous immunoglobulin treatment, and other findings finally lead to a diagnosis of MFS. Because ataxia and ophthalmoparesis can be misdiagnosed as WE during pregnancy, clini-cians should consider MFS in the differential diagnosis.

Keywords: Miller Fisher syndrome, Pregnancy, Wernicke encephalopathy

References

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Table 1.

Comparison of demographic and clinical characteristics between the present case and a previous case⁴

Characteristic	Present case	Ono et al.⁴
Age (years)	31	26
Gestational age (weeks)	8	11
Antecedent infection	Upper respiratory infection	None
Duration of nausea, vomiting, or reduced dietary intake (weeks)	5	3
Wernicke-encephalopathy-related parameters
Nystagmus and ophthalmoplegia	+	+
Change in mental status	–	–
Ataxia	+	+
Abnormal brain MRI findings	None	None
Response to thiamine	Poor	Poor
Initial subjective symptoms of Miller Fisher syndrome	Double vision, gait ataxia	Gait ataxia
Symptoms or signs during the disease course
Dizziness	+	+
Diplopia	+	+
Facial palsy	–	–
Bulbar symptoms or signs	+	–
Limb weakness	–	–
Tingling in limbs	+	–
Areflexia	+	+
Gait ataxia	+	+
Respiratory muscle involvement	–	–
Neurophysiologic findings	Abnormal H-reflex, F-wave, and blink reflex	Unremarkable
Albuminocytologic dissociation	+	–
Antiganglioside antibodies	IgG anti-GQ1b and anti-GT1a An	nti-GQ1b, anti-GD1b, and anti-GT1a
Treatment	IVIg	None
Time to recovery	3 weeks	7 months
Maternal and fetal outcomes	Unknown	Unremarkable

MRI, magnetic resonance imaging; IgG, immunoglobulin G; IVIg, intravenous immunoglobulin.

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