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Case Reports in Neurological Medicine
Volume 2015 (2015), Article ID 472843, 2 pages
http://dx.doi.org/10.1155/2015/472843
Case Report

Atypical Miller Fisher Syndrome with Anisocoria and Rapidly Fluctuating Pupillary Diameter

1Department of Internal Medicine, White Memorial Medical Center, Loma Linda University School of Medicine, 1720 E. Cesar Chavez Avenue, Los Angeles, CA 90033, USA
2Department of Neurology, White Memorial Medical Center, Loma Linda University School of Medicine, 1720 E. Cesar Chavez Avenue, Los Angeles, CA 90033, USA

Received 27 May 2015; Accepted 19 August 2015

Academic Editor: Federico Micheli

Copyright © 2015 Garima Gupta and Antonio Liu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Miller Fisher syndrome is a variant of Guillain-Barre syndrome characterized by the classic triad of ophthalmoplegia, ataxia, and areflexia. Pupillary involvement is common in MFS and has been reported in 35–42% of MFS patients. Although case reports have discussed isolated ophthalmoplegia as a presentation of MFS, anisocoria and rapid fluctuation of pupillary diameter have not been reported in anti-GQ1b antibody positive individuals. Here we describe an individual who presented with diplopia and was found to have progressive internal and external ophthalmoplegia with frequent fluctuations in pupillary diameter and anisocoria. These exam findings are not commonly described even in atypical presentations of MFS. The onset of symptoms was preceded by an upper respiratory infection but no gastrointestinal symptoms. Imaging and CSF studies were unremarkable; however serum levels of immunoglobulin G anti-GQ1b antibody and anti-GAD antibody were elevated confirming the diagnosis of MFS. The patient was treated with IVIG and intravenous steroids with mild resolution of external ophthalmoplegia. He did not go on to develop more typical features of MFS such as ataxia or areflexia. This demonstrates that isolated external and internal ophthalmoparesis with rapidly fluctuating pupillary diameter and associated anisocoria can be the sole manifestation of atypical MFS.