21.04.2020
Miller Fisher Syndrome and polyneuritis cranialis in COVID-19
Diagnostic NeurologyInfectiology
Gutierrez-Ortiz C et al
Neurology
Main result
Two SARS-Cov-2 patients (50 and 39 years-old) confirmed by RT-PCR developed Miller-Fischer syndrome and cranial polyneuritis respectively.
The first patient had right internuclear ophthalmoplegia and right fascicular oculomotor paralysis.
Positive GD1b antibodies pleading in favor of multifocal motor neuropathy. Lumbar puncture revealed hyperproteinuria. Treated with IV immunoglobulins with good recovery.
The second patient had abduction deficits in both eyes and a fixation nystagmus, the upper gaze being more impaired, all compatible with bilateral abducens paralysis. Lumbar puncture also shows a hyperproteinorachia. Anti-ganglioside antibodie profile not performed due to hospital saturation in the context of the pandemic. No specific treatment, good recovery.
In addition, SARS-Cov-2 negative in the CSF.
The first patient had right internuclear ophthalmoplegia and right fascicular oculomotor paralysis.
Positive GD1b antibodies pleading in favor of multifocal motor neuropathy. Lumbar puncture revealed hyperproteinuria. Treated with IV immunoglobulins with good recovery.
The second patient had abduction deficits in both eyes and a fixation nystagmus, the upper gaze being more impaired, all compatible with bilateral abducens paralysis. Lumbar puncture also shows a hyperproteinorachia. Anti-ganglioside antibodie profile not performed due to hospital saturation in the context of the pandemic. No specific treatment, good recovery.
In addition, SARS-Cov-2 negative in the CSF.
Takeaways
The authors suggest to consider covid-19 infection in patients with Miller Fischer syndrome or exhibting any cranial polyneuritis during the pandemic, knowing that the pathogenesis of the latter two involves immune mechanisms or direct viral neuropathonegic effects.
The main mechanism could be an aberrant immune response to the virus.
The main mechanism could be an aberrant immune response to the virus.
Strength of evidence Weak
- Two case report of two cases
- Electromyography with conduction velocities not performed due to difficult circumstances in the pandemic context
- Anti-ganglioside antibody profile not performed for the second patient for the same reasons
- Coincidence or causal relationship?
Objectives
Description of two cases with both SARS-Cov-2 infection and Miller-Fischer syndrome or cranial polyneuritis.
Method
Patient data obtained from medical reports from two hospitals in Madrid.
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