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A rare mimic of acute stroke: rapidly progressing Miller-Fisher Syndrome to acute motor and sensory axonal neuropathy variant of Guillain-Barre Syndrome
  1. Lennie Lynn Chua de Castillo,
  2. Jose Danilo Bengzon Diestro,
  3. Katrina Hannah Dizon Ignacio and
  4. Paul Matthew Dimaguila Pasco
  1. Department of Neurosciences, University of the Philippines Manila College of Medicine and Philippine General Hospital, Manila, Philippines
  1. Correspondence to Dr Lennie Lynn Chua de Castillo, einnelnnyl{at}


Ophthalmoplegia, ataxia and areflexia characterise the clinical triad of Miller-Fisher Syndrome (MFS). When the disease presents acutely, it can mimic posterior circulation stroke. We describe a case of an adult patient presenting with sudden dizziness, diplopia, vomiting, and loss of balance. She was initially managed as a case of a brainstem stroke, but the progression of craniopathies without deterioration in sensorium coupled with areflexia clinched the diagnosis of MFS two days into her admission. On the third day, her MFS progressed rapidly to acute motor and sensory axonal neuropathy (AMSAN) variant of Guillain-Barre Syndrome, a rare occurrence in patients with MFS, with only four reported cases including our own. Among the four cases, ours is the only one still non-ambulatory eight months after the initial onset of symptoms. The case highlights the importance of early recognition of MFS in patients with ophthalmoplegia and ataxia despite initially normal reflexes.

  • Miller-Fisher Syndrome
  • acute motor and sensory axonal neuropathy
  • stroke
  • Guillain-Barre Syndrome

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  • Contributors LLCdC: conceptualised the study, collated and analysed the data, and finalised the paper. KHDI: helped in gathering the data for the case. JDBD and PMDP: edited and proofread the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.

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