A 29-year-old female presents complaining of double vision and unsteadiness

A 29-year-old female presents complaining of double vision and unsteadiness. She has no past medical history of note. On examination she has limited movement of her eyes in all directions. Pupils are 3 mm, equal and reactive to light. Examination of the peripheral nervous system is normal other than reduced reflexes and the plantars are down going. Some past-pointing is also noted. What is the most likely diagnosis?

Multiple sclerosis
Conversion disorder
Miller Fisher syndrome
Ataxic telangiectasia
Friedreich’s ataxia

Dr. Kasper:
Miller Fisher syndrome

Miller Fisher syndrome - areflexia, ataxia, ophthalmoplegia
This patient has Miller Fisher syndrome, a variant of Guillain-Barre syndrome