The pescatorial sixth

Surv Ophthalmol. 2016 Mar-Apr;61(2):248-54. doi: 10.1016/j.survophthal.2015.08.004. Epub 2015 Aug 20.

Abstract

A 56-year-old man with diabetes presented with acute diplopia and signs of bilateral complete abduction deficits. Diffuse areflexia was his only other sign at presentation. Within a few days, he developed complete ophthalmoplegia and ataxia, consistent with a clinical diagnosis of Miller-Fisher syndrome, and repeated history revealed a possible gastroenteritis 3 weeks prior. This case illustrates an "ophthalmoplegia without ataxia" variant of this classic autoimmune condition, which should be considered in patients presenting with bilateral VI nerve palsies.

Keywords: Miller-Fisher syndrome; areflexia; diplopia; ophthalmoplegia; sixth nerve palsy.

Publication types

  • Case Reports

MeSH terms

  • Abducens Nerve Diseases / diagnosis*
  • Abducens Nerve Diseases / drug therapy
  • Ataxia / diagnosis
  • Ataxia / drug therapy
  • Diagnosis, Differential
  • Diplopia / diagnosis
  • Diplopia / drug therapy
  • Drug Therapy, Combination
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunologic Factors / therapeutic use
  • Insulin / therapeutic use
  • Male
  • Middle Aged
  • Miller Fisher Syndrome / diagnosis*
  • Miller Fisher Syndrome / drug therapy
  • Ophthalmoplegia / diagnosis*
  • Ophthalmoplegia / drug therapy
  • Prednisolone / therapeutic use

Substances

  • Glucocorticoids
  • Immunoglobulins, Intravenous
  • Immunologic Factors
  • Insulin
  • Prednisolone