Miller fisher variant of guillain-barré syndrome masquerading as acute sphenoid sinusitis with orbital apex syndrome

Authors

  • Amit Chaudhary BA,

    1. Department of Otolaryngology–Head and Neck Surgery , University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • Tekchand Ramchand BA,

    1. Department of Otolaryngology–Head and Neck Surgery , University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • Larry P. Frohman MD,

    1. Department of Ophthalmology and Visual Sciences , University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    2. Department of Neurology and Neurosciences , University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • James K. Liu MD,

    1. Department of Neurological Surgery , and the University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    2. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey , University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
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  • Jean Anderson Eloy MD, FACS

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery , University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    2. Department of Neurological Surgery , and the University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    3. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey , University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey, U.S.A.
    • Assistant Professor and Vice Chairman, Director of Rhinology and Sinus Surgery, Department of Otolaryngology– Head and Neck Surgery, UMDNJ–New Jersey Medical School, 90 Bergen St., Suite 8100, Newark, NJ 07103
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  • Presented at the Triological Society Combined Sections Meeting, Miami, Florida, U.S.A., January 26–28, 2012.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Miller Fisher syndrome (MFS), a variant of Guillain-Barré syndrome, is a rare disorder typically characterized by a triad of ataxia, areflexia, and ophthalmoplegia, which may have a highly variable clinical presentation. We report a case of MFS in a 45-year-old female presenting with sphenoid sinusitis and sixth nerve palsy. She underwent endoscopic sphenoid sinusotomy without improvement, had postoperative deterioration, was diagnosed with MFS, and was treated with intravenous immunoglobulin with complete response. Because of the potential severity of Guillain-Barré syndrome, great vigilance should be taken when examining sixth nerve palsies to prevent misdiagnosis and delay in treatment of the MFS variant of this disease.

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