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Neurological Rehabilitation

Progressive Neurological Decline and Rehabilitation of Miller-Fisher Syndrome Post-Operatively: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 6
Has Audio

    Primary Author(s)

  • Melina Landry, DO

    Resident PGY-3
    Texas Rehabilitation Hospital of Fort Worth's PM&R Residency Program
    Fort Worth, Texas

    • Poster Presenter(s)

  • Sharon Nguyen, Other

    Medical Student
    University of North Texas HSC Fort Worth Texas College of Osteopathic Medicine
    Fort Worth, Texas

Disclosure(s):
Melina Landry, DO: No financial relationships to disclose
Sharon Nguyen, Other: No financial relationships to disclose
Case Diagnosis: A 29-year-old male with Miller-Fisher Syndrome (MFS).

Case Description or Program Description: A 29-year-old male with a medical history of hypertension, seizure disorder, and childhood hydrocephalus presented to the emergency department with vision changes, left facial droop, and lower extremity weakness. The patient had undergone open cholecystectomy one week prior. The patient was admitted for acute metabolic encephalopathy and seizures due to hyponatremia. After clearance from specialists, the patient was discharged 3 days later. However, his condition worsened, leading to readmission two days later with signs of hallucinations, slurred speech, dysphagia, and inability to walk or stand. Initial magnetic resonance imaging (MRI) revealed no acute neurological abnormalities. Lumbar puncture confirmed a diagnosis of Guillain-Barre syndrome (GBS). The patient was treated with five rounds of intravenous immunoglobulin (IVIG), eventually transferring to a rehabilitation hospital 2 weeks later. Upon admission, the patient was exhibiting tetraparesis, visual field deficits, dysphagia, and dysphonia. Rehabilitation focused on progressive strength, balance, gait training, and respiratory therapy.

Setting: Acute care hospital, followed by an inpatient rehabilitation facility.

Assessment/Results: On admission, the patient’s Modified Rankin Scale (mRS) score was 5, indicating severe disability requiring maximum assistance. Following inpatient therapy, he had independent ambulation with a walker for 150 feet, minimal assistance for activities of daily living (ADLs), and progression to a regular diet. At discharge, his mRS score was 2.

Discussion (relevance): This case highlights the importance of recognizing atypical GBS presentations, such as MFS postoperatively. This patient’s MFS was likely triggered by the cholecystectomy. Early identification and rehabilitation of MFS and other GBS variants play a critical role in functional recovery.

Conclusions: This case demonstrates the efficacy of timely diagnosis and structured rehabilitation in improving functional outcomes for post-operative MFS patients complicated by tetraparesis and visual field deficits. The patient was seen at a 2-month follow-up after participating in outpatient therapy, and demonstrated continued functional improvement.