Fisher syndrome with delayed facial weakness and taste impairment: a case report

Abstract

A 55-year-old man was admitted to our hospital because of acute onset of diplopia and gait disturbance. On admission, ophthalmoplegia, ataxia and areflexia were observed. He was diagnosed with Fisher syndrome and given intravenous immunoglobulin therapy from day 6 to day 10 after disease onset. After treatment, ophthalmoplegia and ataxia began to improve. However, he developed taste impairment on day 13 and right hemifacial weakness on day 16 after onset. A blink reflex test revealed right facial nerve impairment. On day 42 after onset, facial weakness and taste impairment remitted, and the blink reflex test result was normalized without additional treatment. Although it has been known that 10% of patients with Fisher syndrome complicated by delayed facial nerve palsy, the mechanism of the facial nerve palsy has not been elucidated. Therefore, this is a significant report to describe delayed facial nerve palsy combined with taste impairment and successive recordings of blink reflex and facial nerve conduction in a patient with Fisher syndrome.(Rinsho Shinkeigaku (Clin Neurol) 2016;56:684-689)

Additional Steroid Therapy for Delayed Facial Palsy in Miller Fisher Syndrome

“…The findings of electrophysiological studies and MRI in DFP have been presented in some Japanese case reports ( 16 , 17 ). The findings of consecutive electrophysiological studies (blink reflex tests) in DFP were similar to those in idiopathic peripheral partial facial paresis ( 16 , 18 ), although the gadolinium enhancement pattern of the facial nerve on MRI in DFP seemed to differ from that in Bell's palsy ( 17 , 19 ). More studies concerning the volume and quality will be necessary to elucidate the pathophysiology of DFP.…”

Guillain–Barré syndrome with unilateral peripheral facial paralysis in a Chinese child

“…However, our case here did not fit the clinical profile of acute bulbar palsy plus syndrome obviously, which characterised by acute bulbar palsy combined with other cranial symptoms or ataxia without limb and neck weakness (Cao et al, 2020). Therefore, we further summarised the GBS patients with unilateral facial paralysis reported previously (Table 1) (Huang et al, 2021; Iqbal et al, 2016; Kamihiro et al, 2012; Liping et al, 2019; Nishiguchi et al, 2017; Ray & Jain, 2016; Smith et al, 2010; Tan et al, 2015; Tatsumoto et al, 2015; Verma et al, 2012; Yadav et al, 2020; Yamamoto et al, 2016). The literature search showed only 14 patients previously, seven adults (age: 52–65 years) and seven children (age: 10 months to 15 years).…”

Case Report and Literature Analysis: Guillain-Barré Syndrome With Delayed Unilateral Facial Palsy

“…So far, few cases of GBS combined with DFP have been reported. Only 28 cases in seven studies have been described (including our case, listed in Table 1 ) ( 3 – 9 ). Patients' age range was 15–81 years (mean ± SD: 45.44 ± 17.71), 20 (71.4%) were male, and 8 (28.6%) were female, with a male to female ratio of 5:2.…”

“…Further, we review all previous GBS cases combined with DFP, summarizing the clinical features, examination results, and treatment prognosis of such patients. Our study included a total of seven articles (3)(4)(5)(6)(7)(8)(9), with a total of 28 cases, including 14 GBS, 13 MFS, and one MFS/GBS overlapping case. Cases that met the criteria are listed in Table 1.…”