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Miller Fisher syndrome mimicking Wernicke encephalopathy during pregnancy

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초록

Miller Fisher syndrome (MFS) is characterized by ataxia, areflexia, and ophthalmoparesis. Here we present a case of MFS mimicking Wernicke encephalopathy (WE) during pregnancy. A 31-year-old woman at 8 weeks of gestation presented with diplopia and ataxia after experiencing nausea and vomiting for several weeks. We initiated thiamine based on a suspicion of WE, which produced no clear effects. However, her symptoms began to improve following intravenous immunoglobulin treatment, and other findings finally lead to a diagnosis of MFS. Because ataxia and ophthalmoparesis can be misdiagnosed as WE during pregnancy, clinicians should consider MFS in the differential diagnosis.

Abstract

Miller Fisher syndrome (MFS) is characterized by ataxia, areflexia, and ophthalmoparesis. Here we present a case of MFS mimicking Wernicke encephalopathy (WE) during pregnancy. A 31-year-old woman at 8 weeks of gestation presented with diplopia and ataxia after experiencing nausea and vomiting for several weeks. We initiated thiamine based on a suspicion of WE, which produced no clear effects. However, her symptoms began to improve following intravenous immunoglobulin treatment, and other findings finally lead to a diagnosis of MFS. Because ataxia and ophthalmoparesis can be misdiagnosed as WE during pregnancy, clinicians should consider MFS in the differential diagnosis.

참고문헌 (9)

  1. Wakerley BR, "Guillain-Barré and Miller Fisher syndromes--new diagnostic classification", Nat Rev Neurol, 10, pp.537~544 (2014)
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  3. Sharma SR, "Guillain-Barré syndrome complicating pregnancy and correlation with maternal and fetal outcome in North Eastern India: a retrospective study", Ann Indian Acad Neurol, 18, pp.215~218 (2015)
  4. Ono M, "Clinical features of miller-fisher syndrome in pregnancy", Case Rep Obstet Gynecol, 2015, pp.840680~ (2015)
  5. Kim YH, "Wernicke's encephalopathy in hyperemesis gravidarum", Can J Ophthalmol, 37, pp.37~38 (2002)
  6. 김종국, "Prevalence of Anti-Ganglioside Antibodies and Their Clinical Correlates with Guillain-Barré Syndrome in Korea: A Nationwide Multicenter Study", Journal of Clinical Neurology, 10(2), pp.94~100 (2014), 대한신경과학회[DOI]
  7. Chan LY, "Guillain-Barré syndrome in pregnancy", Acta Obstet Gynecol Scand, 83, pp.319~325 (2004)
  8. Arányi Z, "Miller Fisher syndrome: brief overview and update with a focus on electrophysiological findings", Eur J Neurol, 19, pp.15~20 (2012)
  9. Elovaara I, "EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases: EFNS task force on the use of intravenous immunoglobulin in treatment of neurological diseases", Eur J Neurol, 15, pp.893~908 (2008)

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