I recently came across a case of Miller Fisher syndrome, a rare variant of Guillain–Barré syndrome. The patient, a 70 year old male, had presented with normal level of consciousness, generalised weakness, weakness of limbs with inability to stand on his own, intact bladder control and double vision. The brain CT scan came out to be within normal limits.
Miller Fisher syndrome, a triad of ataxia, areflexia and ophthalmoplegia, is quite rare and there is no clear cut guideline to diagnose Miller Fisher. The antibody (anti-GQ1b) test is usually not done in India. So it may be difficult to distinguish MFS from GBS. Both Guillain–Barré and Miller Fisher respond to the same treatment i.e. steroids and immunoglobulins.
The antibody (anti-GQ1b) test, though initially planned, was later considered redundant, as the patient responded well to the treatment. The important clue in this case was the eye involvement (ophthalmoplegia is a feature in Miller Fisher).