Muneto Tatsumoto1, Sonoko Misawa2, Norito Kokubun1, Yukari Sekiguchi2, Koichi Hirata1, Satoshi Kuwabara2, Nobuhiro Yuki3,4. 1. Department of Neurology, Dokkyo Medical University, Tochigi, Japan. 2. Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan. 3. Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 4. Department of Medicine, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Unit 09-01, 14 Medical Drive, 117599, Singapore.
Abstract
INTRODUCTION: Dr. C. Miller Fisher described the appearance of unilateral facial palsy after resolution of ataxia in a patient with the eponymic Miller Fisher syndrome (MFS). However, there have been very few reports of delayed appearance of facial weakness in Guillain-Barré syndrome (GBS) and MFS when the other neurological signs reached nadir or started improving. METHODS: In this study we reviewed the clinical and laboratory findings of consecutive patients with GBS (n=195) and MFS (n=68). RESULTS: Delayed facial weakness occurred in 12 (6%) GBS and 4 (6%) MFS patients and was unilateral in 5 (42%) GBS and 2 (50%) MFS patients. In those patients with delayed facial weakness, neither limb weakness nor ataxia progressed, and facial weakness disappeared without immunotherapy. CONCLUSIONS: Because facial weakness can lead to further morbidity, it would be prudent for clinicians to warn patients of this possibility, although additional immunotherapy is usually not required.
INTRODUCTION: Dr. C. Miller Fisher described the appearance of unilateral facial palsy after resolution of ataxia in a patient with the eponymic Miller Fisher syndrome (MFS). However, there have been very few reports of delayed appearance of facial weakness in Guillain-Barré syndrome (GBS) and MFS when the other neurological signs reached nadir or started improving. METHODS: In this study we reviewed the clinical and laboratory findings of consecutive patients with GBS (n=195) and MFS (n=68). RESULTS:Delayed facial weakness occurred in 12 (6%) GBS and 4 (6%) MFSpatients and was unilateral in 5 (42%) GBS and 2 (50%) MFSpatients. In those patients with delayed facial weakness, neither limb weakness nor ataxia progressed, and facial weakness disappeared without immunotherapy. CONCLUSIONS: Because facial weakness can lead to further morbidity, it would be prudent for clinicians to warn patients of this possibility, although additional immunotherapy is usually not required.