COVID-19 has shown its association with numerous neurological manifestations since its arrival. A case reports a 55-year-old, female infected with SARS-CoV-2, acutely presented with autonomic dysfunction preceding the onset of the complete clinical picture of Miller Fisher syndrome. 

After all the necessary investigations, she was finally diagnosed to be anti-ganglioside antibody-positive post-COVID-19 Miller Fisher syndrome with dysautonomia. She was administered intravenous immunoglobulin 0.4 g/kg/day for five days, which had an excellent response. Her cranial neuropathies and the ataxia improved and she was given a discharge three weeks after admission, with a resolution of the neurological features, except generalized hyporeflexia.

Thus, surveillance is a must to detect and manage COVID-19 associated immune-driven disorders. SARS-CoV-2 induced MFS suspected cases must undergo investigations like- anti-ganglioside antibodies, targeted high-resolution contrast-enhancing MRI, to impart more information regarding the natural history and pathogenesis of the disease. Intravenous immunoglobulin should be initiated as soon as possible to facilitate early recovery and reduce hospital stay. 

Source:  Biswas S, Ghosh R, Mandal A, et al. COVID-19 Induced Miller Fisher Syndrome Presenting With Autonomic Dysfunction: A Unique Case Report and Review of Literature. The Neurohospitalist. May 2021. doi:10.1177/19418744211016709