Miller-Fisher syndrome

This is a much rarer variant of Guillain-Barré syndrome (autoimmune destruction of the myelin sheath of nerves), characterized by rapidly evolving ophthalmoplegia (partial paralysis of the eyes), ataxia (uncoordinated limbs) and areflexia (lack of muscle reflexes) without weakness. It can sometimes simulate a medullary stroke, although the onset of a stroke is sudden whereas this syndrome is progressive. Alternatively, it may simulate botulism due to its progression down the body. A suspected diagnosis is established on the basis of the clinical symptoms, to be confirmed with a blood antibodies test. A positive 2-4 week prognosis can generally be expected but hospital care is required in the event of deterioration and for initiating treatment with immunoglobulins or plasmapheresis, as with the treatment for Guillain-Barré syndrome.