Rare Case of Miller-Fisher Syndrome

Background: As there is high variability of acute inflammatory peripheral neuropathies, clinically diagnosis is difficult, especially differentiating between Guillain-Barre´- and (Miller-) Fisher syndrome (The Brighton Collaboration GBS Working Group).

Case Report: We present a 2.6-year-old girl with infection associated remitting episodes of ataxia, areflexia of the lower limbs and weakness with inability to walk as well as expressive dysphasia with changing leading symptom. Repeated MRI of the head and spine were normal. Cerebral spinal fluid showed blood-brain barrier disruption within normal protein level also in refunction after 3 weeks. Result of ganglioside and aquaporin antibodies was negative. There were no signs for organic acidopathy or ceroid lipofuscinosis. A-wave was positive for two times in otherwise normal nerve velocity conduction. Clinical symptoms resolved under treatment with methylprednisolone. Treatment with immunoglobulins had to be stopped due to allergic reaction.

Results/Conclusion: By leading symptom of ataxia, we diagnosed a rare case of remitting Miller-Fisher syndrome, which resolved under treatment with methylprednisolone. We also thought about a prednisolone responsive cerebellitis and ATP1A3 mutation. Remarkably, there was a change of leading symptom from ataxia to neuropathy in absence of otherwise typical palsy of cranial nerves.