Dizziness, Scanning Speech, and Transient Hyperreflexia as Atypical Initial Manifestations of Antiganglioside Q1b‐Negative Miller Fisher Syndrome: A Case Report and Literature Review
Wenjing Wu, Mengying Mao, Bin Xu, Liang'e XuABSTRACT
Background
Miller‐Fisher syndrome (MFS) is characterized by the triad of ataxia, areflexia, and ophthalmoplegia. To our knowledge, the combination of initial dizziness, scanning speech, transient hyperreflexia with a Babinski sign, and persistent anti‐GQ1b seronegativity has not been previously reported.
Case Presentation
A 27‐year‐old Chinese Han male patient presented with prominent dizziness and scanning speech as the primary symptoms. Physical examination revealed hyperreflexia of all tendon reflexes initially, along with intention tremor and a positive Babinski's sign on the right side. Subsequently, he exhibited the classic triad of MFS, and cerebrospinal fluid analysis showed albuminocytological dissociation. He was ultimately diagnosed with MFS. Electromyography (EMG) revealed significantly abnormal blink reflexes, dysfunction of the brainstem auditory pathway, particularly within the central nervous system, and a descending sensory nerve action potential (SNAP) in the left sural nerve. Cerebral Magnetic Resonance Imaging (MRI) and ganglioside Q1b (GQ1b) antibodies were both negative. After treatment with intravenous immunoglobulin (IVIG) for 5 days, the patient's condition significantly improved. By the 1‐month follow‐up, his neurological function had completely recovered.
Conclusion
The involvement of dizziness, scanning speech, hyperreflexia, and Babinski's sign in anti‐GQ1b‐negative MFS is quite rare, indicating early central nervous system (CNS) involvement. The pathogenesis of MFS may have a broader immunological basis rather than being solely attributable to a single autoantibody‐mediated response against gangliosides.