Abstract

Background: Miller Fisher Syndrome (MFS) is a rare immune-mediated variant of Guillain-Barré Syndrome characterised by ophthalmoplegia, ataxia, and areflexia. It typically presents following an upper respiratory or gastrointestinal infection and may involve rapid cranial nerve dysfunction, making it an important differential diagnosis in acute neuromuscular weakness. Miller Fisher syndrome can also present with uncommon symptoms such as bulbar involvement, facial and somatic muscle palsies, and micturition disturbance. Anti-GQ1b antibodies are present in most cases of MFS. The diagnosis is based on clinical features supported by electrophysiological and laboratory findings. Early recognition is critical, especially in emergency settings, due to the potential risk of airway compromise and autonomic instability. Treatment includes supportive care and intravenous immunoglobulin. Case Presentation: We present the case of a 23-year-old female who developed progressive difficulty in speaking, swallowing, and drooling of saliva, followed by upper limb weakness. Neurological examination revealed ophthalmoplegia, ptosis, bilateral facial weakness, an absent gag reflex, and upper-limb areflexia without ataxia. Cerebrospinal fluid analysis was normal with negative anti-GQ1b antibodies, while nerve conduction studies showed demyelinating polyneuropathy. Based on the clinical presentation and NCS findings, a diagnosis of MFS–GBS overlap syndrome was considered. The patient was treated with intravenous immunoglobulin (IVIG) and other supportive measures, with gradual clinical improvement. Conclusion: This case underscores the diagnostic challenges associated with MFS variants and highlights the need for high clinical suspicion in atypical presentations

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