Topic outline

  • Grand Rounds

    A patient presented with binocular diplopia of 2 weeks duration after COVID-19 infection. Additionally, she had neurological symptoms, weakness, tingling, numbness of extremities. She had been fully vaccinated against COVID-19. On exam her BCVA was 20/20 OU, she was noted to have ophthalmoplegia with ptosis. She was sent to emergency room for a full work including spinal tap. Her MRI brain showed signs consistent with Wernicke’s encephalopathy and she was treated with IV thiamine. However, her symptoms worsened during the period of her hospital stay, she reported choking and she was noted to have hyporeflexia on exam. Her CSF analysis was normal. An MRI of the spine was ordered, and it showed multiple enhancing nerve roots at various spinal levels. A ganglioside antibody panel was ordered and was normal. This patient’s clinical presentation and worsening of symptoms over the course of time after COVID-19 infection, additional finding of multiple enhancing nerve roots pointed towards a diagnosis of Miller Fisher syndrome. She received treatment with IVIG per protocol and was discharged from the hospital in a stable condition.

    This talk discusses the clinical presentation, course, possible mechanisms of causation, lab work, neuroimaging and other ancillary testing for establishing diagnosis of case of Miller Fisher syndrome after COVID-19. Also, discussed is the proposed treatment regimen and outcomes of treatment. We have also reviewed the previously available literature on this rare entity.

    Presentation Date: 03/10/2022
    Issue Date: 03/18/2022