{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:10:18Z","timestamp":1756275018978,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,7,7]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>A 71-year-old woman presented to the emergency room with dysphonia, diplopia, dysphagia and generalised weakness since that day. Neurological examination revealed eye adduction limitation, ptosis, hypoactive reflexes and gait ataxia. Blood and cerebrospinal fluid analysis and brain CT were normal. Electromyography revealed a sensory axonal polyneuropathy. She was diagnosed with Miller-Fisher syndrome (MFS) and started on intravenous immunoglobulin. Two days after intravenous immunoglobulin treatment was completed, she developed a sustained hypertensive profile and presented a generalised tonic-clonic seizure. Brain MRI was suggestive of posterior reversible encephalopathy syndrome (PRES) and supportive treatment was implemented with progressive improvement. PRES may be a possible complication of MFS not only due to autonomic and inflammatory dysfunctions, but also as a consequence of its treatment. Patients with MFS should be maintained under close surveillance, especially in the first days and preferably in intermediate care units.<\/jats:p>","DOI":"10.1136\/bcr-2021-242231","type":"journal-article","created":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T12:35:18Z","timestamp":1626352518000},"page":"e242231","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Posterior reversible encephalopathy syndrome following Miller-Fisher syndrome"],"prefix":"10.1136","volume":"14","author":[{"given":"Catarina","family":"Bernardes","sequence":"first","affiliation":[{"name":"Neurology Department, Centro Hospitalar e Universit\u00e1rio de Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristiana","family":"Silva","sequence":"additional","affiliation":[{"name":"Neurology Department, Centro Hospitalar e Universit\u00e1rio de Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Santo","sequence":"additional","affiliation":[{"name":"Neurology Department, Centro Hospitalar e Universit\u00e1rio de Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"In\u00eas","family":"Correia","sequence":"additional","affiliation":[{"name":"Neurology Department, Centro Hospitalar e Universit\u00e1rio de Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,15]]},"reference":[{"key":"2025082622405417000_14.7.e242231.1","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1212\/CON.0000000000000513","article-title":"Guillain-Barre syndrome","volume":"23","author":"Donofrio","year":"2017","journal-title":"Continuum"},{"key":"2025082622405417000_14.7.e242231.2","unstructured":"Rocha Cabrero F , Morrison EH . Miller Fisher syndrome. Treasure Island (FL): StatPearls Publishing LLC, 2020."},{"key":"2025082622405417000_14.7.e242231.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00111-8"},{"key":"2025082622405417000_14.7.e242231.4","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1007\/s00415-016-8377-8","article-title":"Posterior reversible encephalopathy syndrome","volume":"264","author":"Fischer","year":"2017","journal-title":"J Neurol"},{"key":"2025082622405417000_14.7.e242231.5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.5692\/clinicalneurol.cn-001089","article-title":"[Case of posterior reversible encephalopathy syndrome caused by Fisher syndrome]","volume":"58","author":"Yokoi","year":"2018","journal-title":"Rinsho Shinkeigaku"},{"key":"2025082622405417000_14.7.e242231.6","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1590\/0100-3984.2015.0129","article-title":"Posterior reversible encephalopathy syndrome following immunoglobulin therapy in a patient with Miller-Fisher syndrome","volume":"49","author":"Ribeiro","year":"2016","journal-title":"Radiol Bras"},{"key":"2025082622405417000_14.7.e242231.7","doi-asserted-by":"crossref","first-page":"e423","DOI":"10.1016\/j.jstrokecerebrovasdis.2014.05.034","article-title":"Posterior reversible encephalopathy syndrome and stroke after intravenous immunoglobulin treatment in Miller-Fisher syndrome\/Bickerstaff brain stem encephalitis overlap syndrome","volume":"23","author":"Stetefeld","year":"2014","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2025082622405417000_14.7.e242231.8","doi-asserted-by":"publisher","DOI":"10.1159\/000087720"},{"key":"2025082622405417000_14.7.e242231.9","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s10286-018-0542-y","article-title":"Autonomic involvement in Guillain-Barr\u00e9 syndrome: an update","volume":"29","author":"Zaeem","year":"2019","journal-title":"Clin Auton Res"},{"key":"2025082622405417000_14.7.e242231.10","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.73.3.333"},{"key":"2025082622405417000_14.7.e242231.11","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2016-216757"},{"key":"2025082622405417000_14.7.e242231.12","doi-asserted-by":"crossref","first-page":"3663","DOI":"10.1007\/s10072-020-04496-1","article-title":"Posterior reversible encephalopathy and Guillain-Barr\u00e9 syndrome: which came first, the chicken or the egg? A review of literature","volume":"41","author":"Storti","year":"2020","journal-title":"Neurol Sci"},{"key":"2025082622405417000_14.7.e242231.13","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2018.01299","article-title":"Adverse effects of immunoglobulin therapy","volume":"9","author":"Guo","year":"2018","journal-title":"Front Immunol"},{"key":"2025082622405417000_14.7.e242231.14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jns.2017.06.044","article-title":"Corticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome","volume":"380","author":"Parikh","year":"2017","journal-title":"J Neurol Sci"},{"key":"2025082622405417000_14.7.e242231.15","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1159\/000500410","article-title":"Positive effect of steroids in posterior reversible encephalopathy syndrome","volume":"11","author":"Meyer","year":"2019","journal-title":"Case Rep Neurol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-242231","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T05:41:07Z","timestamp":1756273267000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-242231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":15,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,15]]},"published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1136\/bcr-2021-242231"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-242231","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}