Cranial nerve enhancement on three-dimensional MRI in Miller Fisher syndrome

Miller Fisher syndrome (MFS) is characterized by an acute onset of external ophthalmoplegia, cerebellar ataxia, and areflexia. Because MFS is often preceded by an episode of acute inflammatory symptoms and, in most cases, the neurologic symptoms recover after a certain period of time, the disease is regarded as a variant of Guillain-Barre syndrome (GBS). [1] Although the involvement of peripheral nerves is evident in GBS, controversy still exists as to the localization of lesions in MFS. [2] Here we report two cases of MFS in which, using contrast-enhanced three-dimensional (3-D) MRI, the abducens and oculomotor nerves were enhanced by Gd-DTPA. The patient was a 26-year-old man with a history of transient diarrhea and sore throat 1 week before he complained of diplopia and unstable gait. On admission (the fifth day of illness), his external ocular movements were limited to all directions with the right abducens nerve being most severely affected. His gait was ataxic and his deep tendon reflexes …