Miller-Fisher syndrome and Guillain–Barre syndrome overlap syndrome following inactivated COVID-19 vaccine: Case report and scope review

Figures & data

Figure 1. The PRISMA 2020 flow diagram of publication identification.

Table 1. Clinical characteristics and prognosis of published cases of Miller-Fisher syndrome following COVID-19 vaccination.

Author, y	Dang, 2021^Citation6	Yamakawa, 2022^Citation12	Nishiguchi, 2021^Citation7	Abičić, 2021^Citation13	Kim, 2021^Citation14	Kubota, 2022^Citation15	Assiri, 2022^Citation5	Siddiqi, 2022^Citation16	Michaelson, 2021^Citation17	Present case
Demographic data
Age	63	30	71	24	84	65	37	53	78	64
Gender	Male	Male	Male	Female	Female	Male	Male	Male	Male	Male
Country	Australia	Japan	Japan	Croatia	South Korea	Japan	Syria	Pakistan	United States	China
Previous events
Previous medication	-	-	Diabetes	-	NA	Diabetes, glaucoma, BPPV	-	Hypertensive ischemic heart disease	Inflammatory pseudotumor	Cholecystitis, gastritis, gallstone
Preceding infection	-	-	-	-	-	-	-	-	COVID-19	unclear
Vaccine type	ChAdOx1/S	BNT162b2	BNT162b2	BNT162b2	ChAdOx1/S	BNT162b2	BNT162b2	Inactivated	BNT162b2	Inactivated
Number of dose	First	Second	First	First	First	Second	First	First	Second	Second
Time from vaccine to symptom onset (d)	14	7	18	18	8	17	9	8	14	12
Clinical presentations
Limb weakness	+	-	-	-	-	-	-	+	-	-
Limb paresthesia	+	-	-	-	-	-	-	+	+	+
Facial palsy	+	-	-	-	-	-	-	+	-	+
Affected side	Bilateral	-	-	-	-	-	-	Right	-	Right
Ophthalmoplegia	+	+	+	+	+	+	NA	+	+	+
Affected side	Bilateral	Bilateral	Bilateral	Bilateral	Bilateral	Right	-	Right	Bilateral	Bilateral
Ataxia	+	+	+	-	+	-	NA	+	+	+
Deep tendon reflex	Absent	Absent	Normal	Normal	Absent	Normal	NA	Absent	Absent	Absent
Respiration failure	-	-	-	-	-	-	-	-	+	-
Other neurological symptoms	Lower back pain	Dizziness	Headache, ocular pain	-	-	-	Dysphagia, dysarthria	Myalgias	-	Dizziness, headache
Auxiliary examinations
MRI/enhanced MRI	Bilateral oculomotor and facial nerve	Normal	Normal	Normal	NA	Right oculomotor nerve	NA	Normal	Normal	Normal
NCS (limbs)	Abnormal	Normal	Normal	NA	Normal	Normal	NA	Abnormal	NA	Abnormal
CSF	Albumin-cytological dissociation	Normal	Albumin-cytological dissociation	Albumin-cytological dissociation	Albumin-cytological dissociation	Albumin-cytological dissociation	NA	Albumin-cytological dissociation	Albumin-cytological dissociation	Albumin-cytological dissociation
Anti-ganglioside antibody	Negative	GQ1b-IgG (+) GT1a-IgG (+)	Negative	GQ1b-IgG (+)	GQ1b-IgG (+)	GQ1b-IgG (+)	NA	NA	Equivocal	GQ1b-IgG (+) GT1b-IgG (+)
Treatment
Type	IVIG	IVIG	IVIG	IVMP, IVIG	None	IVIG	IVIG	Physiotherapy	IVIG	IVIG, acupuncture
Duration (d)	5	5	5 × 2	3, 5	-	5	5	42	5	2, 20
Length of hospital stay (d)	28	NA	52	NA	17	19	7	NA	NA	8
Time from symptom to treatment (d)	NA	12	29	NA	-	31	NA	NA	NA	21
Prognosis
Outcome	Improved	Recovered	Improved	Improved	Improved	Recovered	NA	Recovered	Improved	Recovered
Duration (d)	42 (after onset)	105 (after onset)	88 (after onset)	21 (after treatment)	30 (after onset)	71 (after onset)	NA	112 (after treatment)	3 (after treatment)	54 (after onset)

BBPV: benign paroxysmal positional vertigo; CSF: cerebrospinal fluid; MRI: magnetic resonance imaging; NCS: nerve conduction study; NA: not available; GQ1b-IgG: ganglioside Q1b-Immunoglobulin G; GT1a-IgG: ganglioside T1a-Immunoglobulin G; GT1b-IgG: ganglioside T1b-Immunoglobulin G; IMVP: intravenous methylprednisolone; IVIG: intravenous immunoglobulin.

Dang YL, Bryson A. Miller-Fisher syndrome and Guillain-Barre syndrome overlap syndrome in a patient post Oxford-AstraZeneca SARS-CoV-2 vaccination. BMJ Case Rep. 2021;14:e246701. doi:10.1136/bcr-2021-246701.

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Kubota T, Hasegawa T, Ikeda K, Aoki M. Case report: isolated, unilateral oculomotor palsy with anti-GQ1b antibody following COVID-19 vaccination. F1000res. 2021;10:1142. doi:10.12688/f1000research.74299.1.

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Assiri SA, Althaqafi RMM, Alswat K, Alghamdi AA, Alomairi NE, Nemenqani DM, Ibrahim ZS, Elkady A. Post COVID-19 vaccination-associated neurological complications. Neuropsychiatr Dis Treat. 2022;18:137–54. doi:10.2147/NDT.S343438.

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Siddiqi AR, Khan T, Tahir MJ, Asghar MS, Islam MS, Yousaf Z. Miller Fisher syndrome after COVID-19 vaccination: case report and review of literature. Medicine (Baltimore). 2022;101:e29333. doi:10.1097/MD.0000000000029333.

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Michaelson NM, Lam T, Malhotra A, Schiff ND, MacGowan DJL. Miller Fisher syndrome presenting after a second dose of Pfizer-BioNtecH vaccination in a patient with resolved COVID-19: a case report. J Clin Neuromuscul Dis. 2021;23:113–15. doi:10.1097/CND.0000000000000376.

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Data availability statement

Data are available on reasonable request.