title: Nerve ultrasound in Miller Fisher variant of Guillain-Barré syndrome.
abstract: BACKGROUND
  Focal enlargement of the peripheral and spinal nerves, visualized using high-resolution ultrasound (HRUS), has been reported in early Guillain-Barré syndrome, but not in the Miller Fisher variant. We report the use of HRUS in 2 patients who presented with acute ataxic neuropathy, areflexia, and ophthalmoparesis.
  
  
  METHODS
  Ultrasound and/or nerve conduction studies (NCS) of peripheral nerves, the vagus, and spinal nerves C5/6 were performed at onset and 2 weeks after immunoglobulin therapy.
  
  
  RESULTS
  Both patients fulfilled criteria for diagnosis of Miller Fisher syndrome (MFS). Laboratory findings revealed elevated ganglioside Q1b antibodies in both and an albuminolocytologic dissociation in 1 patient. In addition, 1 patient had NCS evidence for demyelinating neuropathy. However, ultrasound showed focal enlargement in the vagus, the spinal nerves, and/or in the peripheral nerves in both patients. After therapy, nerve enlargement decreased in parallel with clinical improvement.
  
  
  CONCLUSIONS
  Spinal and/or peripheral nerve enlargement supports the diagnosis of MFS in early phases of the disease.
authors.affiliation: Department of Neurology, Basel University Hospital, Petersgraben 4, CH-4031, Basel, Switzerland.
authors.forename: Bernhard F
authors.initials: BF
authors.lastname: Décard
authors.affiliation: Department of Neurology, Basel University Hospital, Petersgraben 4, CH-4031, Basel, Switzerland.
authors.forename: Joachim
authors.initials: J
authors.lastname: Fladt
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Axer
authors.affiliation: Department of Neurology, Basel University Hospital, Petersgraben 4, CH-4031, Basel, Switzerland.|Division of Neuropaediatrics, University Children's Hospital Basel, Basel, Switzerland.|University Clinic of Internal Medicine, Kantonsspital Baselland, Bruderholz, Switzerland.
authors.forename: Dirk
authors.initials: D
authors.lastname: Fischer
authors.affiliation: Department of Neurology, Basel University Hospital, Petersgraben 4, CH-4031, Basel, Switzerland.|Department of Neurology and Epileptology, University of Tuebingen, Tuebingen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Grimm
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000097:blood; D005732:Gangliosides / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019846:Miller Fisher Syndrome / Q000000981:diagnostic imaging* / Q000473:pathology*; D009431:Neural Conduction / Q000502:physiology; D010525:Peripheral Nerves / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014463:Ultrasonography
chemical_list: D000906:Antibodies; D005732:Gangliosides; C019403:ganglioside, GD2
keywords: Guillain-Barré syndrome; Miller-Fisher syndrome; demyelinating polyneuropathy; immune-mediated neuropathy; nerve ultrasonography