Male, 59 years old, with acute onset of truncal ataxia, right gaze weakness, hyperreflexia, high suspicion for Miller Fisher variant of GBS. Brain:A 3 mm focus of hyperintensity is seen within the subcortical white matter of the right precentral gyrus. No other areas of significant parenchymal signal abnormality are seen. No restricted diffusion is detected. There is no edema or mass effect. No pathologic parenchymal or extra-axial enhancement is seen. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid is detected. The ventricles are within normal limits.Cervical spine:Straightening of the cervical lordosis is likely positional. Sagittal alignment is unremarkable. Vertebral body morphology is unremarkable. No concerning marrow replacement or pathologic marrow enhancement is seen. A Schmorl's node deformity is seen at T3-4.The visualized spinal cord demonstrates normal signal intensity throughout. No pathologic intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Disc osteophyte formation with a central disc extrusion which contacts and minimally deforms the cord. No significant generalized canal stenosis seen. No significant foraminal narrowing is evident. C4-5: Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Moderate left foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.
1.No specific lesions are seen in the brain or cervical spine to correlate with the suspected Miller Fisher syndrome.2.Disc degeneration is seen in the cervical spine, most notably affecting the C3-4 level where there is a disc extrusion which mildly impinges on the cord.