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Posterior reversible encephalopathy syndrome following Miller-Fisher syndrome
  1. Catarina Bernardes,
  2. Cristiana Silva,
  3. Gustavo Santo and
  4. Inês Correia
  1. Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Catarina Bernardes; acatarinabernardes{at}gmail.com

Abstract

A 71-year-old woman presented to the emergency room with dysphonia, diplopia, dysphagia and generalised weakness since that day. Neurological examination revealed eye adduction limitation, ptosis, hypoactive reflexes and gait ataxia. Blood and cerebrospinal fluid analysis and brain CT were normal. Electromyography revealed a sensory axonal polyneuropathy. She was diagnosed with Miller-Fisher syndrome (MFS) and started on intravenous immunoglobulin. Two days after intravenous immunoglobulin treatment was completed, she developed a sustained hypertensive profile and presented a generalised tonic-clonic seizure. Brain MRI was suggestive of posterior reversible encephalopathy syndrome (PRES) and supportive treatment was implemented with progressive improvement. PRES may be a possible complication of MFS not only due to autonomic and inflammatory dysfunctions, but also as a consequence of its treatment. Patients with MFS should be maintained under close surveillance, especially in the first days and preferably in intermediate care units.

  • peripheral nerve disease
  • neuro ITU
  • neuroimaging
  • epilepsy and seizures
  • cranial nerves

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Footnotes

  • CB and CS contributed equally.

  • Contributors CB and CS contributed to the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article and final approval of the version to be submitted. GS contributed to the analysis and interpretation of data and final approval of the version to be submitted. IC contributed to the conception and design of the study, analysis and interpretation of data and final approval of the version to be submitted.

  • 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.

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