Miller Fisher syndrome with sinus arrest

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Nobuko Shiraiwa *
Mitsumasa Umesawa
Sachiko Hoshino
Tsuyoshi Enomoto
Susumu Kusunoki
Akira Tamaoka
Norio Ohkoshi
(*) Corresponding Author:
Nobuko Shiraiwa | shiraiwa@xa2.so-net.ne.jp

Abstract

Dysautonomia in Guillain-Barre syndrome (GBS) rarely causes serious cardiovascular complications, such as sinus arrest. Miller Fisher syndrome (MFS) is recognized as a variant of GBS. There have been few reports regarding the association between MFS and dysautonomia. We describe a case of a 68-year-old man with ophthalmoplegia, bulbar palsy, truncal ataxia, and areflexia. He was diagnosed with MFS because he exhibited the classical clinical triad and had elevated serum anti- GQ1b immunoglobulin G levels. A magnetic resonance imaging scan of his head was normal. His 24-hour Holter recording showed sinus arrest. He was treated with intravenous immunoglobulin, whereupon his symptoms gradually improved. This included the sinus arrest, which was considered a symptom of dysautonomia in MFS. Therefore, clinicians should be mindful of dysautonomia not only in GBS patients, but also in cases of MFS.

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