Miller fisher syndrome: a case report and differential diagnoses
Journal Title: Revista Cuarzo - Year 2016, Vol 22, Issue 2
Abstract
olyneuropathies of immunological origin such as Guillain-Barré syndrome (GBS) and its variant Miller-Fisher syndrome (SMF) have an incidence of 0.6 to 2.4 cases per 100,000 inhabitants per year, more frequent in men and with a tendency increased in Colombia by infection with the Zika virus. Here is a clinical case of a 66-year-old patient who is taken by his relative to the emergency department for presenting a clinical course consisting of dysarthria, diadocho-kinesias, weakness and paresthesia in lower limbs, does not tolerate standing, and associates antecedent of infl uenza. It is decided to hospitalize, with probable diagnoses of a Cerebellar Syndrome, Hemiplegia alternating or Cerebral Cerebrovascular Event in progress. It enters the UCI when it worsens neurologically and enters respiratory failure; as-sociates hypertension, taquibradi syndrome, hyperglycemia, alteration of oxygenation and ventilation; diagnostic tests are available to rule out neuroinfection or neurodegenerative disease, associated pathologies were monitored in parallel to the recovery of their initial neurological state, and on day 19, they were again transferred to hospital inpatient rooms with tracheostomy and percutaneous gastrostomy. Being on fl oors, Magnetic Nuclear Resonance (MRI) is used whose results and the neurological evolution of the patient lead to electromyography of upper limbs with normal fi ndings, so it is decided to carry out the diagnostic management for diseases of immunological origin. An immunological profi le is requested, obtaining positive results for ANAS and Parietal anti-cell antibodies. Given these fi ndings and given the patient’s favorable response to corticosteroid management, an acute infl ammatory neuropathic disease of immunologic origin of the SMF type or Myasthenia Gravis type. Management with intravenous immunoglobulin is initiated and the patient responds with adequate evolution. With a negative report for anti-acetylcholine receptor antibodies, myasthenia gravis is ruled out and, in view of the stable condition and favorable neurological outcome of the patient, the patient is given a home hospitalization with a diagnosis of acute infl ammatory neuropathy of the SMF type. Conclusion: the diag-nosis of polyneuropathy is confusing and requires a doctor to know the differential diagnoses associated with clinical symptoms of acute polyneuropathy, to make the correct diagnosis and therapeutic treatment of the patient and to favor their evolution with favorable outcomes.
Authors and Affiliations
Páez Tovar, J. , Ruiz Barrera, M. , Rodríguez Delgado, M. , Arango Patiño, L. , & Barrera Céspedes, M.
Keywords
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- EP ID EP694607
- DOI https://doi.org/10.26752/cuarzo.v22.n2.206
- Views 137
- Downloads 0
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