Age: 66.0
Sex: F
Vaccine: FLUX, PPV
Symptoms: Muscle spasms, Myoclonus, Neurological symptom, Nuclear magnetic resonance imaging normal, Pain in extremity
Clinical narrative: This case was reported in a literature article and described the occurrence of miller fisher syndrome in a 66-year-old female subject who was vaccinated with influenza vaccine (Flu vaccine, manufacturer unspecified), and PNEUMOVAX. The subject's medical conditions included no viral type illness. The subject was fully independent with the activities of daily living as well as ambulatory. She had no medical limitations. In October 2007 one week prior to the symptoms the subject received unspecified dose of Flu vaccine (unknown), unspecified dose of PNEUMOVAX (unknown). On 21 October 2007 the subject went to hospital after progressively worsening neurological complaints. One week or so before admission she experienced headache, soon associated with some numbness and tingling in hands and feet, and later associated with dysarthria and swallowing difficulties. The subject was evaluated by neurology with multiple tests. Magnetic resonance imaging and magnetic resonance scan demonstrated no significant abnormality that could have caused her symptoms. With the subject's history, physical and diagnostic testing done noted stability in her course, no worsening but have not much improvement either. She felt somewhat weaker on her left versus the right, but noted significant difficulties with coordinating her movements. She also had residual numbness and tingling involving her face, the inside of her mouth the lower extremities in a knee sock type distribution and in a glove distribution in her upper limbs. She admitted to facial weakness with some dysarthria. However she noted improvement in her face and in her speaking. The subject experienced some intermittent bouts of pain. She had pain in her limbs, particularly in legs described as a combination of burning pain, cramping and irritating numbness and tingling. The subject was treated with gabapentin. She also developed "spells" where she experienced an autonomic instability giving her 3-10 min period of dizziness, change in vision, headache and hypotension. On physical examination the subject had difficulty in her feet with digit identification as well as proprioception, which was absent at her toes. Light touch sensation was decreased beginning at about the mid thigh level and gradually worsening down to her toes. Upper extremity sensation was not as markedly decreased as in her feet but there was decreased light touch sensation in bilateral hands as well as decreased vibratory sensation. Myoclonus was present bilaterally in both lower extremities Rotational dystonia was present in her ankles, more pronounced on her left side. Digit identification was intact in her hands. With manual muscle testing in general she had 4.5 strength in her limbs with hand intrinsics being weaker, but she was able to give some minimal resistance with intrinsic testing. Reflexes were obtained at her ankle, 1+ at the knee and 1+ in her upper extremities. Extraocular movements were intact. No nystagmus was noted. Mild facial weakness was noted bilaterally. Her speech was mildly dysarthric. There was significant ataxia with attempts at gross as well as fine motor movements, more pronounced in the lower extremities versus the upper extremities. At the time of reporting the outcome of the events was unspecified. The author considered the subject's risk factor that was believed to have led to her disease was the Flu vaccine and/or PNEUMOVAX vaccination a week prior to the symptoms.