A case of fisher syndrome with bilateral horizontal gaze nystagmus in the abducent direction

Abstract

Miller Fisher syndrome (MFS) was first described in 1956 by Miller Fisher as an unusual variant of acute idiopathic polyneuritis. It is a variant of Guillain-Barre syndrome that is characterized by ophthalmoplegia, ataxia, and areflexia. High titers of serum IgG reactivity to GQ 1 b ganglioside are detected in patients with MFS. Here, we report the case of a patient who exhibited horizontal nystagmus on the lateral gaze position early in the onset and was diagnosed with MFS. A 45-year-old woman was admitted to our hospital with rotatory vertigo 12 days after being diagnosed with an influenza A infection. Two days after hospitalization, she showed bilateral horizontal gaze nystagmus in the abducent direction. At the same time, a central nerve system disorder was suspected as a result of neurotological findings; she was diagnosed with MFS. The vertigo improved after the administration of intravenous immunoglobulin therapy and she was discharged 11 days after hospitalization. This is a rare case of MFS after influenza A infection. There may be an association between anti-GQ 1 b antibodies and peripheral or brainstem disorders.