The Diagnosis is Made Only with Suspicion: Miller Fisher Syndrome

Miller Fisher syndrome (MFS) is an uncommon variant of Guillain-Barré syndrome (GBS) characterised by external ophthalmoplegia, ataxia, and areflexia. This syndrome is observed in about 5% of all GBS cases. Miller-Fisher syndrome can be distinguished from GBS by a few clinical features. As the laboratory findings are not specific for MFS, the diagnosis is made only with suspicion of the disease. The aim of this report was to remind the MFS to emergency physicians and to emphasize the differential characteristics and treatment of this neurological emergency. We reported the clinical features of two patients who were diagnosed to have MFS in the emergency department. Emergency physicians should not underestimate the flu like illness together with the typically clinical triad of MFS in the possibility of variant MFS. The first dose IVIG therapy in the ED may be an important factor for early recovery of the patients who have clinically severe findings. (Hong Kong j.emerg.med. 2011;18:428-431)