Huang Jin, Lin Lingling, Huang Xuerong, Yan Xiaoxiao
Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Front Med (Lausanne). 2025 Sep 8;12:1575696. doi: 10.3389/fmed.2025.1575696. eCollection 2025.
Miller-Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome, classically characterized by a triad of symptoms, including ataxia, areflexia, and ophthalmoplegia. However, only a few cases have documented clinical data on a rare atypical presentation of MFS, with headache and ophthalmoplegia as the initial manifestation. We report an 83-year-old Chinese female patient with no history of respiratory or gastrointestinal infection presented with headache and ophthalmoplegia. Cerebrospinal fluid analysis showed albuminocytological dissociation, along with positive anti-GQ1b antibodies, leading to a diagnosis of incomplete Miller-Fisher syndrome. The patient's headache symptoms were relieved following immunoglobulin treatment, and ophthalmoplegia resolved within 20 days. A literature search identified eight cases of MFS patients initially presenting with headaches, followed by ophthalmoplegia. Detection of anti-ganglioside antibodies in serum or cerebrospinal fluid enables early diagnosis of MFS, and early immunoglobulin treatment improves patient prognosis.
米勒-费雪综合征（MFS）是吉兰-巴雷综合征的一种罕见变异型，典型表现为三联征症状，包括共济失调、腱反射消失和眼肌麻痹。然而，仅有少数病例记录了以头痛和眼肌麻痹为初始表现的MFS罕见非典型表现的临床资料。我们报告了一名83岁的中国女性患者，无呼吸或胃肠道感染史，以头痛和眼肌麻痹为表现。脑脊液分析显示蛋白细胞分离，同时抗GQ1b抗体阳性，从而诊断为不完全性米勒-费雪综合征。免疫球蛋白治疗后患者的头痛症状缓解，眼肌麻痹在20天内消退。文献检索发现8例MFS患者最初表现为头痛，随后出现眼肌麻痹。检测血清或脑脊液中的抗神经节苷脂抗体可实现MFS的早期诊断，早期免疫球蛋白治疗可改善患者预后。
