Clinical Practice and Cases in Emergency Medicine

Introduction: Guillain-Barré syndrome (GBS) can manifest with progressive paralysis, requiring careful monitoring and treatment with steroids or IVIG. While this disease can be devastating and require ICU level of care, there are few incidences of GBS relapses.

Case Report:  A 67-year-old man with a past medical history of Miller Fisher Syndrome (MFS) variant Guillain-Barre Syndrome (GBS), with complete recovery presenting to the emergency department (ED) with ataxia, ophthalmoplegia, dysphonia, and ambulatory dysfunction. The patient noticed his neurologic symptoms after waking up and presented to the ED with physical examination positive for difficulty with upward gaze, mild right lower facial droop, dysmetria with left finger to nose testing, and unsteady gait.  A lumbar puncture (LP) revealed albuminocytologic dissociation and he was diagnosed with recurrent MFS. The patient completed a five-day course of intravenous immunoglobulin with marked improvement of his symptoms. Unfortunately, the patient continued to have ambulatory difficulty, requiring inpatient rehabilitation with residual deficits including ophthalmoplegia and mild dysphonia.

Conclusion: MFS is an uncommon variant of GBS with atypical neurologic findings that can lead to respiratory distress that requires high levels of suspicion and diagnostic evaluation.  This disease process can recur in a patient’s lifetime, contrary to traditional medical literature.