Morning Report: An Uncommon Presentation of an Uncommon Disease

Clinical Pearls:

  • Guillan-Barre Miller Fisher Variant: Classical triad is ophthalmoplegia, ataxia, areflexia but all three are not necessary. About 25% of these patients will have limb weakness. Additionally, you can see a descending paralysis rather than ascending paralysis.
  • Romberg Test: Maintaining balance while standing requires 2 out of 3 of the following – Proprioception, vision, vestibular apparatus. Patient’s with cerebellar ataxia will generally be unable to balance with their eyes open so the Rhomberg’s test is not a test of cerebellar function.
  • Albumino-cytologic dissociation on LP, preceding viral URI or Gastroenteritis, 30% Campylobacter
  • TCA Toxicity can cause numbness, tingling, transaminitis, extrapyramidal symptoms, ataxia.

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