skip to main content

Miller Fisher syndrome — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

EasyNeuromuscularMiller Fisher syndromeSCE Neurology

A 55-year-old man presented with acute diplopia, ataxia and areflexia after respiratory infection. On examination, there was ophthalmoplegia but preserved limb power. Initial investigations showed: anti-GQ1b antibodies were positive. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Nerve conduction studies and EMG

Nerve conduction studies and EMG is the best answer because the vignette describes Miller Fisher syndrome: ophthalmoplegia, ataxia and areflexia define Miller Fisher syndrome. Video-EEG telemetry is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Temporal artery ultrasound and biopsy pathway and EEG with sleep-deprived recording are less appropriate because they would require different localisation, timing or test findings; MRI internal auditory meatus with gadolinium would fit a different syndrome. Clinical pearl: Wernicke encephalopathy causes confusion and nutritional context.

Reference: NICE NG42; ABN myasthenia gravis guidance; EAN/PNS GBS-CIDP guidance