Not All Facial Droops Are Stroke: Miller Fisher Syndrome Presenting as a Stroke Mimic

Miller Fisher syndrome (MFS) is a rare acquired neuropathy resulting from an acute infection and is believed to be a variant of Guillain-Barre syndrome (GBS). Its characteristic features are triads of ataxia, areflexia and ophthalmolegia, though involvement of cranial nerves is possible. Our case report describes a middle-aged man who presented as a potential stroke patient with left-sided facial droop, dysphagia and weakness. Upon in-depth clinical examination and basic investigations, stroke was deemed unlikely and clinical diagnosis of MFS was reached. This was further confirmed by the presence of anti-GQ1b antibody and anti-GT1a antibody in the serological study. Our patient was closely monitored with spirometry checks and only received supportive therapy throughout his treatment course until he achieved full clinical recovery. From this case we learnt that the clinical manifestations of MFS may vary depending on the presence of different types of autoantibodies. Similar to GBS, management of MFS is also largely supportive. Despite the widespread use of intravenous immunoglobulins with or without plasmapheresis to treat MFS, there is no conclusive evidence yet regarding prioritizing one treatment over another as the disease itself is self-limiting.