My story

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 …