A Case Report of Overlapping Miller Fisher Syndrome, Guillain-Barré Syndrome, and the Bickerstaff Brainstem Encephalitis

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Abstract

Introduction:

Patients with overlapping Miller Fisher syndrome (MFS), Guillain-Barré syndrome (GBS), and the Bickerstaff brainstem encephalitis (BBE) have rarely been reported, and the diverse clinical features and sequelae are challenging for physicians. Through this case report, we present the clinical course, treatment, recovery, and sequelae of an overlapping MFS, GBS, and BBE syndrome and provide a review of the literature.

Case Report:

A 76-year-old woman was initially presented with diplopia, ophthalmoplegia, and ataxia, but she later developed weakness of limbs, respiratory failure, deterioration of consciousness, and cognitive impairment. After IV immunoglobulin and corticosteroid therapy, she began to recover consciousness and from the weakness from day 18. After 8 months of rehabilitative therapy, she was able to swallow food without difficulty, but she still cannot walk without assistance, showed cognitive impairment, and the tracheostomy remained in place because of persistent respiratory muscle weakness.

Conclusions:

As the clinical course of MFS-GBS-BBE overlapping syndrome is variable, involving not only the peripheral but also the central nervous system, the establishment of a comprehensive therapeutic strategy is warranted.

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