Case Report

Ataxia, Ophthalmoplegia, and Areflexia: What Would You Think?

Table 2

Cases of proven cancer associated with Miller Fisher Syndrome.

AuthorTumourPresentationCSFNCSImagingAnti-GQ1bOutcomePostmortem findings if performed

Tahrani et al. [57]Anaplastic adenocarcinoma of pancreasTwo weeks of worsening mobility and diplopia O/E: bilateral ophthalmoplegia, L LMN VII, areflexia, and generalised weaknessProt 0.65, WCC 12 (lymphocytes)Non contrast
MRI
NAD
−veDiedYes but brain not studied

Aki et al. [56]Chronic lymphocytic leukaemiaNeutropaenia and fever during chemotherapy with diplopia and arm weakness O/E: areflexia, ophthalmoplegia, dysphagia, dysarthria, shoulder weakness, and ataxiaNADAxonal sensory motor neuropathyMRI
NAD
−vePlasmapheresis with total improvement

Gentile et al. [55]Burkitt’s lymphomaDiplopia
O/E: bilateral ophthalmoplegia, areflexia, and gait ataxia
Prot 1.45, no cells, cytology negativeDiffuse axonal neuropathyMRI
NAD
−veSome improvement with chemotherapy

De Toni et al. [54]Squamous cell carcinoma of lungProgressive hand and feet numbness, unsteady gait
O/E: general weakness, sensory ataxia, impaired sensation to all modalities, and areflexia
Protein 0.9, WC 14, no cytologyDiffuse axonal sensory polyneuropathy+ve and on lung histologyIVIg, slowly worsened and progressed

Rubio-Nazabal et al. [53]Hodgkin’s lymphomaFever and weight loss then bilateral diplopia, photophobia, dysphonia, and gait instability on chemotherapy
O/E: ophthalmoplegia, fixed and dilated pupils, dysphonia, mild dysphagia, VII palsy, and ataxia
Protein 0.79, WCC 2, normal lymphocytes on cytologyAxonal sensory neuropathyMRI with contrast NAD+veIVIg, slowly improved over 2 weeks