Posters

An overlap syndrome of Guillain-Barré and Miller Fisher

Poster Details

First Author: M. Loureiro PORTUGAL

Co Author(s):    T. Resse Santos   H. Morais   F. Sousa Neves   R. Rothwell   D. Meira        

Abstract Details

Purpose:

Guillain-Barré syndrome (GBS) was considered a single disorder, but now it is recognized as a heterogeneous syndrome with several variant forms, distinguished by their clinical, pathophysiologic, and pathologic features. We intend to describe a case report of an overlap syndrome of Guillain-Barré and Miller-Fisher

Setting:

Department of ophthalmology of Centro Hospitalar de V. N. Gaia

Methods:

A 78-year-old caucasian man, previously healthy, presented bilateral external ophthalmoplegia, bilateral facial weakness, dysarthria, dysphonia, dysphagia, tetraparesis grade 4+, global arreflexia, hypoesthesia in glove/sock and steppage walk, after a recent upper respiratory tract infection.

Results:

Blood tests (including serology and immunology) yielded normal results. Cerebrospinal fluid (CSF) was acellular and showed high protein concentration (83 mg/dL); all other parameters were within normal ranges. MRI of the brain and whole spine were normal. Electromyography (EMG) showed a demyelinating polyneuropathy. Tests for anti-ganglioside antibodies were negative. He was diagnosed with an overlap syndrome of GB/MF and was treated with a course of intravenous immunoglobulin, with progressive improvement.

Conclusions:

The diagnosis of MFS was determined based on clinical signs, albumin-cytological dissociation in CSF, and after ruled out other processes. Although anti-GQ1b IgG antibodies are present in more than 90% of MFS cases, they are not essential to diagnose. Furthermore, the demyelinating polyneuropathy in EMG favors the existence of an overlap syndrome of GB/MF, combining features of the two entities, with few cases described in the literature.

Financial Disclosure:

NONE