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RESUMO Relato de caso de um paciente do sexo masculino internado no pronto socorro de um hospital com síndrome de Miller Fisher (SMF). A SMF é caracterizada pela presença de uma tríade de sinais: oftalmoparesia, arreflexia e ataxia, podendo apresentar outros sinais menos frequentes como alterações de fala e de deglutição. A partir da avaliação fonoaudiológica foi possível identificar disfagia orofaríngea de grau grave, hipernasalidade vocal e outras alterações fonoarticulatorias. O paciente apresentou boa evolução a partir de uma terapêutica multiprofissional integrada, incluído atendimento fonoaudiológico.
SUMMARY The case report of a male patient admitted to the emergency hospital with the diagnosis of Miller Fisher syndrome (MF), is presented. MFS is characterized by the presence of a triad of signs: ophthalmoparesis, areflexia and ataxia, and may present other less frequent signs such as speech and swallowing disorders. On the basis of findings during the speech therapy evaluation it was possible to identify severe oropharyngeal dysphagia, vocal hypernasality and other speech disorders. The patient presented a good evolution following an integrated multi-professional treatment program, including speech-language therapy.
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BACKGROUND AND PURPOSE: Miller Fisher syndrome (MFS) is a subtype of Guillain-Barré syndrome characterized by the triad of ophthalmoparesis, areflexia, and ataxia. Although cases of MFS have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, no studies have synthesized the clinical characteristics of patients with this condition. METHODS: In this rapid systematic review, we searched the PubMed database to identify studies on MFS associated with SARS-CoV-2 infection. RESULTS: This review identified 11 cases, of whom 3 were hospitalized with motor and/or sensory polyneuropathy as the first sign of SARS-CoV-2 infection. SARS-CoV-2 RNA was not detected in analyses of cerebrospinal fluid, suggesting a mechanism of immune-mediated injury rather than direct viral neurotropism. However, antiganglioside antibodies were found in only two of the nine patients tested. It is possible that target antigens other than gangliosides are involved in MFS associated with SARS-CoV-2 infection. CONCLUSIONS: The present patients exhibited clinical improvement after being treated with intravenous immunoglobulin. Although rare, patients with SARS-CoV-2 infection may present neurological symptoms suggestive of MFS. Early recognition of the MFS clinical triad is essential for the timely initiation of treatment.
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PURPOSE: Report a case series study of individuals who, after having a suspected arboviral disease during an epidemic outbreak in north-eastern Brazil, presented symptoms of acroparesthesia. METHODS: A retrospective evaluation of patients with acroparesthesia undertaken between December 2015 and October 2016 following a clinical picture suggestive of an arboviral infection. RESULTS: Clinical and electrophysiological data were obtained from 29 individuals. 13% were male. All presented a main complaint of numbness in the hands, with 86% presenting bilateral symptoms. The symptoms started within 60â¯days of the clinical picture in 62% of cases. The electrophysiological study demonstrated CTS in 54 median nerves. It was classified as mild in 24.1% of cases, moderate in 32.7%, severe in 24.1%, very severe in 6.8% and extremely severe in 5.1%. CONCLUSION: The best explanation for the presence of acroparesthesia following an arboviral infection may be the narrowing of the carpal tunnel caused by the inflammatory joint process usually observed in cases of chikungunya infection. CLINICAL RELEVANCE: This is the first study with electrophysiological data that associates arboviral infection with CTS.