Reza and Rabih talk through a case
RLR #2 – Hoarseness
A 54-year-old man with a history of PTSD, depression, and a recent diarrheal illness presented with acute dysphagia to liquids and solids. Neurologic exam was initially unremarkable, but the patient returned the next day with diplopia and ataxia. Exam was notable for new bilateral cranial nerve III palsies and areflexia. Laryngoscopy revealed unilateral vocal cord paralysis. Cerebrospinal fluid analysis was notable for elevated protein and positive GQ1b antibody testing. He was diagnosed with Miller Fisher’s syndrome, a variant of Guillain-Barre Syndrome.
- Miller Fisher’s Syndrome(MFS) is a rare variant of Guillain-Barre syndrome (acute inflammatory demyelinating polyneuropathy) that primarily affects the bulbar nerves. MFS is suggested by the classic triad of acute-onset ophthalmoplegia, ataxia, and areflexia and often occurs following a prodromal illness (upper respiratory infection or gastroenteritis). Diagnosis is supported by elevated cerebrospinal fluid protein as well as demonstration of GQ1b ganglioside autoantibodies (which are positive in 85% of cases). Prognosis is typically favorable, and most cases are self-limited.