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The annual incidence of Miller Fisher syndrome is about 0.1 per 100 000 population in the UK.1 According to the World Health Organization, there are about 20 000 neurologists in Western Europe, the USA and Canada. Two of them will have the Miller Fisher syndrome in this century. I was one of those two and would like to report my own case, review the syndrome and communicate my personal experience with the disease.
At the age of 51 years, I woke up with double vision due to a left trochlear palsy 10 days following the beginning of a heavy cough with fever. My tendon reflexes were decreased on the left. Neck and brain arteries as well as brainstem imaging were all normal. I thought I had a parainfectious trochlear palsy and attributed the depressed tendon reflexes to my tension during the examination by one of my colleagues. However, the next morning I had trouble standing up and instantly thought that I might have the Miller Fisher syndrome, but was sceptical because it is so rare. I was admitted to hospital where I had bilateral mild ptosis, dilated pupils not reacting to light and opthalmoplegia sparing only a little adduction and down gaze. Deep tendon reflexes were by then largely absent, peripheral motor functions were normal and I had slight limb and moderate truncal and gait ataxia. Sensory functions were unaffected except for numbness of my fingertips. CSF protein concentration was …