Pattern of Extraocular Muscle Involvements in Miller Fisher Syndrome

Ryu, Won Yeol; Kim, Yoo Hwan; Yoon, Byeol A; Park, Hwan Tae; Bae, Jong Seok; Kim, Jong Kuk

doi:10.3988/jcn.2019.15.3.308

Cited by 15 publications

(14 citation statements)

References 20 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our patient, elevation deficit was most prominent symptom with esotropia (near and far) and consequential diplopia. According to Ryu et al ( 7 ) the lateral rectus muscle was most frequently involved (100%), followed by the superior (60%), inferior (52%), and medial (48%) rectus muscle. Most frequent form of ocular deviation was esotropia (64%).…”

Section: Discussionmentioning

confidence: 99%

Ocular Manifestations of Miller Fisher Syndrome: a Case Report

et al. 2021

View full text Add to dashboard Cite

Background: Miller Fisher syndrome (MFS) is a variant of Guillain-Barré syndrome and is characterised by a clinical triad of ophthalmoplegia, ataxia and areflexia. Objectives: This report presents an atypical case of MFS characterized by ocular and gastrointestinal involvement, and anti-ganglioside antibody-positivity. Methods: A 17-year old boy was referred to our ophthalmology emergency room with signs and symptoms of diplopia and upper lid ptosis of the right eye. He underwent a complete ophthalmologic examination with special reference to strabologic status, as well as a neuropediatric examination with serum antiganglioside antibody panel. Results: Strabologic examination showed horisontal diplopia (near and far), ptosis of the upper eyelid on the right and bilateral ophthalmoplegia (limited elevation). Orthoptic examination revealed esotropia of 8 prism dioptres (PD) at near and 18 PD at far distance. A pediatric neurologist found normal limb power, deep tendon reflexes and flexor plantar responses, but attenuated right patellar reflex. Serum anti-GQ1b IgG (+++), anti-GQ1b IgM (++) and anti-GD1a IgM(++) were positive. Positivity of anti-GQ1b IgG antibody confirmed the existence of incomplete MFS. We treated the patient with systemic intravenous immunoglobulins for five days, and after five months of follow-up, all symptoms resolved. Conclusion: MFS can present itself as a wide range of clinical features and its timely recognition is important. Despite the alarming nature of the disease, patients with MFS tend to have a good recovery of presented symptoms, and without any significant residual deficit.

show abstract

Section: Discussionmentioning

confidence: 99%

Ocular Manifestations of Miller Fisher Syndrome: a Case Report

et al. 2021

View full text Add to dashboard Cite

show abstract

“…3 In Miller–Fisher syndrome, dysfunction of the LR, due to involvement of the abducens nerve, is most commonly involved and the last to recover. 27 Interestingly in Miller–Fisher syndrome, the ophthalmoparesis is mostly symmetrical. 27 …”

Section: Clinical and Radiological Clues From The Different Combinati...mentioning

confidence: 99%

“…3 In Miller-Fisher syndrome, dysfunction of the LR, due to involvement of the abducens nerve, is most commonly involved and the last to recover. 27 Interestingly in Miller-Fisher syndrome, the ophthalmoparesis is mostly symmetrical. 27 In brain disease with ophthalmoparesis, ptosis is unusual except for brain stem pathology such as brain stem tumours.…”

Section: Clinical and Radiological Clues From The Different Combinati...mentioning

confidence: 99%

Clinical and imaging clues to the diagnosis and follow‐up of ptosis and ophthalmoparesis

Keene

Kan

Meeren

et al. 2022

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

Ophthalmoparesis and ptosis can be caused by a wide range of rare or more prevalent diseases, several of which can be successfully treated. In this review, we provide clues to aid in the diagnosis of these diseases, based on the clinical symptoms, the involvement pattern and imaging features of extra‐ocular muscles (EOM). Dysfunction of EOM including the levator palpebrae can be due to muscle weakness, anatomical restrictions or pathology affecting the innervation. A comprehensive literature review was performed to find clinical and imaging clues for the diagnosis and follow‐up of ptosis and ophthalmoparesis. We used five patterns as a framework for differential diagnostic reasoning and for pattern recognition in symptomatology, EOM involvement and imaging results of individual patients. The five patterns were characterized by the presence of combination of ptosis, ophthalmoparesis, diplopia, pain, proptosis, nystagmus, extra‐orbital symptoms, symmetry or fluctuations in symptoms. Each pattern was linked to anatomical locations and either hereditary or acquired diseases. Hereditary muscle diseases often lead to ophthalmoparesis without diplopia as a predominant feature, while in acquired eye muscle diseases ophthalmoparesis is often asymmetrical and can be accompanied by proptosis and pain. Fluctuation is a hallmark of an acquired synaptic disease like myasthenia gravis. Nystagmus is indicative of a central nervous system lesion. Second, specific EOM involvement patterns can also provide valuable diagnostic clues. In hereditary muscle diseases like chronic progressive external ophthalmoplegia (CPEO) and oculo‐pharyngeal muscular dystrophy (OPMD) the superior rectus is often involved. In neuropathic disease, the pattern of involvement of the EOM can be linked to specific cranial nerves. In myasthenia gravis this pattern is variable within patients over time. Lastly, orbital imaging can aid in the diagnosis. Fat replacement of the EOM is commonly observed in hereditary myopathic diseases, such as CPEO. In contrast, inflammation and volume increases are often observed in acquired muscle diseases such as Graves' orbitopathy. In diseases with ophthalmoparesis and ptosis specific patterns of clinical symptoms, the EOM involvement pattern and orbital imaging provide valuable information for diagnosis and could prove valuable in the follow‐up of disease progression and the understanding of disease pathophysiology.

show abstract

“…After excluding case reports, studies from Korea and Japan were included for comparison (15,16). Clinical characteristics of the reviewed cases are demonstrated in Table 4.…”

Section: Literature Reviewmentioning

confidence: 99%

Clinical features and differences of Miller Fisher syndrome in southern China: Retrospective analysis of 72 patients from 13 provinces in southern China

Ding

Chu

et al. 2022

Preprint

View full text Add to dashboard Cite

Objectives: We aimed to analyze the clinical features of Miller Fisher syndrome (MFS) in southern China and compare it features presenting in other countries. Methods: Medical records of patients with a diagnosis of Guillain-Barré syndrome (GBS) admitted to 31 tertiary hospitals, located in 13 provinces in southern China, from 1 January 2013 to 30 September 2016, were collected and retrospectively reviewed. Results: A total of 72 patients (36 from rural area and 36 from urban area) were enrolled. Their age at onset was 47.42±15.65 years old. Winter (29.2%) and spring (41.7%) were the seasons with the peak incidence of MFS. Thirty-eight (52.8%) patients had a history of upper respiratory tract infection one week before onset, while 4 (5.6%) patients experienced gastrointestinal infections. Among the 65 patients who underwent lumbar puncture, 48 (73.8%) patients exhibited albumincytologic dissociation in the cerebrospinal fluid study. Overall, 83.5% patients presented with limited outward movement of the eye, 64.2% had bilateral symmetrical ophthalmoplegia, and only 25.4% had unilateral ophthalmoplegia. No significant differences were observed between the rural and urban areas, such as age of onset (p=0.777) or sex distribution (p=0.609). Patients with complete ophthalmoplegia were older than those with incomplete ophthalmoplegia ( 64.53±7.69 years vs 43.19±14.40 years, p<0.001). Conclusion: Winter and spring are the peaks of MFS incidence. The incidence is higher in men than in women. The most common pattern of ophthalmoplegia in MFS is bilateral symmetrical ophthalmoplegia, There is no urban-rural difference in MFS in southern China. Patients with complete ophthalmoplegia were older than incomplete ophthalmoplegia. There is no significant difference of MFS between southern China and other East Asian countries.

show abstract

Pattern of Extraocular Muscle Involvements in Miller Fisher Syndrome

Cited by 15 publications

References 20 publications

Ocular Manifestations of Miller Fisher Syndrome: a Case Report

Ocular Manifestations of Miller Fisher Syndrome: a Case Report

Clinical and imaging clues to the diagnosis and follow‐up of ptosis and ophthalmoparesis

Clinical features and differences of Miller Fisher syndrome in southern China: Retrospective analysis of 72 patients from 13 provinces in southern China

Contact Info

Product

Resources

About