P100 | A peculiar onset of sudden confusion and muscular weakness

Background: Miller Fisher-Bickerstaff Syndrome is an acute idiopathic polyneuritis characterized by the sudden onset of ataxia, ophthalmoplegia, areflexia, alterations of consciousness. It is more common in males, with an average onset age of 44 years. In 80-90% of patients antibodies against GT1a and GQ1b are present. Case report: A 55-year-old woman presented to the emergency room with fever, shaking chills, and abdominal pain. Abdominal CT revealed right pyelonephritis. During the hospitalization there was a sudden ideomotor slowdown, slurred speech, and persistent headache. She also exhibited a tendency to drowsiness and profound asthenia. Neurological examination revealed dysarthria, hypophonia, mild bilateral ptosis, diplopia on lateral gaze, easy fatigability of neck muscles and MingazziniI-II, with weak knee reflexes and absent Achilles reflexes. The search for anti-GT1a and GQ1b antibodies was negative. Electromyography indicated acute polyneuro-radiculopathy with predominant involvement of the upper limbs and facial region, with sign of possible involvement of the brainstem. Intravenous immunoglobulin (Igev) therapy was administered for 5 days, followed by a fast recovery. Conclusions: Miller Fisher syndrome is a rare form of Guillain-Barré syndrome, often triggered by an infection, typically respiratory, present in approximately 72% of cases, with an average latency of 10 days. Spontaneous complete recovery is usually achieved within 2-3 months of onset. Usually at 6 months no residual disabilities are observed.