Ataxic Guillain–Barré syndrome with anti-GQIb antibody: Relation to Miller Fisher syndrome

To the Editor:

I have followed Yuki et al.’s work on Miller Fisher syndrome (MFS) and its variants for some time.1 I believe the authors are mistaken on the following points: 1) making any distinction between Fisher and Bickerstaff syndromes2,3⇓; and 2) ignoring cardinal signs of CNS involvement in Fisher and Guillain–Barré syndromes such as ballism (first described by Dr. Yuki himself), opsoclonus, myoclonus, Babinski sign, internuclear ophthalmoplegia, and, in this case, cerebellar ataxia. I believe these mistakes are rooted in blindly following authority, lacking a historical perspective on the issue,1 and an unfounded belief that a normal conventional MRI means absence of a CNS lesion. On the issues of ignoring cardinal signs of CNS involvement and following “certain well established ideas” on Guillain–Barré they are in the company of no less a luminary than Fisher himself, with a major distinction: Yuki et al. are living in the wonderful age of computerized neuroimaging.1 A normal conventional MRI means nothing in this context for the following reasons: …