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Only five cases of optic nerve involvement in Miller Fisher syndrome (MFS) have been documented in the literature. This report further confirms that optic neuritis may be seen in anti-GQ1b positive MFS.
This 23 year old woman presented with acute blurry vision, diplopia, and pain with eye movement. Her visual acuity was 20/20 right eye and 20/200 left eye with a left relative afferent pupillary defect (RAPD). She had left red colour desaturation. Her visual field on tangent screen revealed an enlarged left blind spot and a left upper quadrant temporal peripheral field constriction. She had bilateral sixth nerve palsies, nystagmus in all gazes, and left optic disc oedema. After 1 week her visual acuity improved to 20/20 in both eyes, but her left disc remained oedematous. She then developed rapidly progressive gait ataxia to such a degree that she was unable to walk. Dysmmetria and dysdiadochokinesia were more marked in her left upper extremity. She had very mild distal lower extremity weakness, absent lower extremity deep tendon reflexes, and bilateral Babinski’s. She also had tingling in her hands and feet and decreased lower extremity vibratory sensation. Her mental status was normal throughout her illness. She was not taking any drugs. A magnetic resonance image (MRI) of the brain and entire spine and MR venogram were all normal. Her cerebrospinal fluid …