COVID-19-associated Miller-Fischer syndrome

Jump to: navigation, search

WikiDoc Resources for COVID-19-associated Miller-Fischer syndrome

Articles

Most recent articles on COVID-19-associated Miller-Fischer syndrome

Most cited articles on COVID-19-associated Miller-Fischer syndrome

Review articles on COVID-19-associated Miller-Fischer syndrome

Articles on COVID-19-associated Miller-Fischer syndrome in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on COVID-19-associated Miller-Fischer syndrome

Images of COVID-19-associated Miller-Fischer syndrome

Photos of COVID-19-associated Miller-Fischer syndrome

Podcasts & MP3s on COVID-19-associated Miller-Fischer syndrome

Videos on COVID-19-associated Miller-Fischer syndrome

Evidence Based Medicine

Cochrane Collaboration on COVID-19-associated Miller-Fischer syndrome

Bandolier on COVID-19-associated Miller-Fischer syndrome

TRIP on COVID-19-associated Miller-Fischer syndrome

Clinical Trials

Ongoing Trials on COVID-19-associated Miller-Fischer syndrome at Clinical Trials.gov

Trial results on COVID-19-associated Miller-Fischer syndrome

Clinical Trials on COVID-19-associated Miller-Fischer syndrome at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on COVID-19-associated Miller-Fischer syndrome

NICE Guidance on COVID-19-associated Miller-Fischer syndrome

NHS PRODIGY Guidance

FDA on COVID-19-associated Miller-Fischer syndrome

CDC on COVID-19-associated Miller-Fischer syndrome

Books

Books on COVID-19-associated Miller-Fischer syndrome

News

COVID-19-associated Miller-Fischer syndrome in the news

Be alerted to news on COVID-19-associated Miller-Fischer syndrome

News trends on COVID-19-associated Miller-Fischer syndrome

Commentary

Blogs on COVID-19-associated Miller-Fischer syndrome

Definitions

Definitions of COVID-19-associated Miller-Fischer syndrome

Patient Resources / Community

Patient resources on COVID-19-associated Miller-Fischer syndrome

Discussion groups on COVID-19-associated Miller-Fischer syndrome

Patient Handouts on COVID-19-associated Miller-Fischer syndrome

Directions to Hospitals Treating COVID-19-associated Miller-Fischer syndrome

Risk calculators and risk factors for COVID-19-associated Miller-Fischer syndrome

Healthcare Provider Resources

Symptoms of COVID-19-associated Miller-Fischer syndrome

Causes & Risk Factors for COVID-19-associated Miller-Fischer syndrome

Diagnostic studies for COVID-19-associated Miller-Fischer syndrome

Treatment of COVID-19-associated Miller-Fischer syndrome

Continuing Medical Education (CME)

CME Programs on COVID-19-associated Miller-Fischer syndrome

International

COVID-19-associated Miller-Fischer syndrome en Espanol

COVID-19-associated Miller-Fischer syndrome en Francais

Business

COVID-19-associated Miller-Fischer syndrome in the Marketplace

Patents on COVID-19-associated Miller-Fischer syndrome

Experimental / Informatics

List of terms related to COVID-19-associated Miller-Fischer syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyed Arash Javadmoosavi, MD[2]

Synonyms and Keywords: MFS, fisher syndrome

Overview

Miller Fisher Syndrome (MFS) is an acute peripheral neuropathy that can develop after exposure to a viral or bacterial infection. It includes triad of ophthalmoplegia, areflexia and ataxia. In COVID-19 pandemic period, while COVID-19 typically presents with fever, shortness of breath (SOB) and respiratory symptoms, MFS with prior history of COVID-19 has been seen in several cases all around the world. One retrospective study in 214 patients has shown that 8.9 % of COVID-19 patients have reported peripheral neurological symptoms.

Historical Perspective

  • The first reported case of MFS with a history of COVID-19 was detected in January 2020 in Shanghai, who was a middle-aged woman diagnosed with MFS presented with areflexia, acute weakness in both legs and severe fatigue.
  • Further reports were announced by medical groups in Spain and the USA which presented neuro-ophtalmological symptoms. [1]

Classification

Pathophysiology

Causes

Differentiating COVID-19-associated Miller-Fischer syndrome from other Diseases

  • For further information about the differential diagnosis, click here.
  • To view the differential diagnosis of COVID-19, click here.

Epidemiology and Demographics

  • While the incidence of MFS is one or two-person per million each year, the prevalence of MFS associated with COVID-19 is still unknown.

Risk Factors

Screening

  • There is insufficient evidence to recommend routine screening for patients with MFS caused by COVID-19.

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

  • Although the diagnosis of COVID-19 is based on respiratory symptoms, it can be associated with neurological symptoms, which overlap the diagnosis of MFS.
  • Consequently, inpatient with prior history of COVID-19, other neurologic diseases should be ruled out and anti-GQ1b antibody test should be considered.
  • Also, in new patients with suspicious symptoms for COVID-19 and neurological symptoms, a nasal swab test and neurological examination should be considered.
  • MRI may be performed as a part of the diagnostic workup. Although in majority of cases no abnormality is detected, enlargement and prominent enhancement in orbits and retro-orbital region has been reported in some cases.[3]. [4]

History and Symptoms

Common symptoms

Less common symptoms

Physical Examination

  • Patients with covid-19 associated with MFS present various signs and symptoms related to systematic and neurological presentation. Hence physical examination should be performed based on signs and symptoms include:

Vitals

Abnormal signs associated with covid-19:

Neurological

Laboratory Findings

  • Laboratory findings consistent with the diagnosis of COVID-19 include positive PCR nasal swab.
  • Laboratory tests for neurological signs are not diagnostic and should be used with other clinical parameters. They include:

Electrocardiogram

X-ray

Echocardiography or Ultrasound

  • Lung ultrasound may be helpful in the evaluation of patients with COVID-19. It indicates :

CT scan

The preliminary findings of CT in COVID-19 associated with MFS include:

MRI

  • Brain MRI may be helpful in the diagnosis of MFS in patients with prior history of COVID-19 and neurological manifestations.
  • Although there can be no abnormalities, multiple cranial nerve enhancement has been reported in some patients.

Other Diagnostic Studies

  • There are no other diagnostic studies associated with COVID-19 with MFS manifestations.

Treatment

Medical Therapy

Surgery

  • Surgical intervention is not recommended for the management of covid-19.

Primary Prevention

  • Effective measures for the primary prevention of covid-19 include hand-washing, wearing of face masks, social distancing, avoidance of large gathering and self-isolation for patients who have mild symptoms.

References

  1. {{https://n.neurology.org/content/early/2020/04/17/WNL.0000000000009619}}
  2. {{https://pubmed.ncbi.nlm.nih.gov/10695710}}
  3. {{http://www.ajnr.org/content/early/2020/05/28/ajnr.A6609}}
  4. {{https://rarediseases.org/rare-diseases/miller-fisher-syndrome/}}
  5. {{http://www.ajnr.org/content/early/2020/05/28/ajnr.A6609}}
  6. {{https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141645/}}
  7. Cao, Bin; Wang, Yeming; Wen, Danning; Liu, Wen; Wang, Jingli; Fan, Guohui; Ruan, Lianguo; Song, Bin; Cai, Yanping; Wei, Ming; Li, Xingwang; Xia, Jiaan; Chen, Nanshan; Xiang, Jie; Yu, Ting; Bai, Tao; Xie, Xuelei; Zhang, Li; Li, Caihong; Yuan, Ye; Chen, Hua; Li, Huadong; Huang, Hanping; Tu, Shengjing; Gong, Fengyun; Liu, Ying; Wei, Yuan; Dong, Chongya; Zhou, Fei; Gu, Xiaoying; Xu, Jiuyang; Liu, Zhibo; Zhang, Yi; Li, Hui; Shang, Lianhan; Wang, Ke; Li, Kunxia; Zhou, Xia; Dong, Xuan; Qu, Zhaohui; Lu, Sixia; Hu, Xujuan; Ruan, Shunan; Luo, Shanshan; Wu, Jing; Peng, Lu; Cheng, Fang; Pan, Lihong; Zou, Jun; Jia, Chunmin; Wang, Juan; Liu, Xia; Wang, Shuzhen; Wu, Xudong; Ge, Qin; He, Jing; Zhan, Haiyan; Qiu, Fang; Guo, Li; Huang, Chaolin; Jaki, Thomas; Hayden, Frederick G.; Horby, Peter W.; Zhang, Dingyu; Wang, Chen (2020). "A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19". New England Journal of Medicine. 382 (19): 1787–1799. doi:10.1056/NEJMoa2001282. ISSN 0028-4793.
  8. "Coronavirus disease 2019 (COVID-19) investigational drug information for remdesivir".
  9. "Corticosteroids | Coronavirus Disease COVID-19".