Case of the Month #14 - Miller Fisher syndrome

Published 02/02/2022

What management would be appropriate?

  • Up to 25% pf patients with Guillain-Barré will develop respiratory failure. Close monitoring and proactive management are key – however, do not assume all cases are due to neuromuscular dysfunction. Other causes of respiratory failure should be excluded (or treated!).
  • There is limited evidence for the use of non-invasive BiPAP or high flow nasal oxygen therapy, but a trial of either may be considered to reduce work of breathing.
  • Autonomic dysfunction is a concerning sign and should prompt critical care referral for ongoing management. Fluctuations are common, so caution should be used if treating hypertension, to avoid precipitating subsequent refractory hypotension – short acting agents are advised if the hypertension must be treated.
  • Caution with spirometry in cases involving facial weakness, as this weakness can affect the lip-grip on the spirometry mouth piece, causing inaccurate results.
  • Specific management involves either plasma exchange or IV immunoglobulins.
  • There is no evidence to suggest steroids are effective.
  • Critical care admission may be prolonged, so supportive care is vitally important, including nutrition, effective analgesia, early physiotherapy, VTE prophylaxis and psychological support.