Miller-Fisher syndrome with posterior reversible encephalopathy syndrome and stroke that developed as a complication of intravenous immunoglobulin therapy

Abstract

A 50-year-old woman with progressive ocular palsy, ataxia and sensory impairment who was diagnosed with anti-GQ1b antibody-positive Fisher syndrome (FS) was initially treated with intravenous immunoglobulin (IVIg). However, weakness in the left upper limb developed due to arterial hypertension 3 days later. Magnetic resonance imaging showed an intracranial hemorrhage in the right frontal and parietal lobes, and the areas of hyperintensity in the left frontal and the bilateral occipital white matter, cortex and bilateral cerebellum. The IVIg was discontinued because the arterial hypertension caused posterior reversible encephalopathy syndrome (PRES). The symptoms further progressed to include facial palsy, dysarthria and dysphagia, indicating advanced FS. Immunoadsorption plasmapheresis ameliorated the course of the disease, hastened recovery and improved functional outcomes to the point where the patient was transferred to a rehabilitation hospital. This experience supports the notion that IVIg can lead to complicating PRES that can cause the progression of extant FS.