Miller-Fisher Syndrome and Guillain-Barre Syndrome overlap syndrome in a patient post Oxford-AstraZeneca SARS-CoV-2 vaccination

BMJ Case Rep. 2021 Nov 30;14(11):e246701. doi: 10.1136/bcr-2021-246701.


We describe a patient who developed bilateral oculomotor nerve palsy, ataxia, facial diplegia and lower limb weakness 2 weeks post-Oxford-AstraZeneca SARS-CoV2 vaccination, consistent with Miller-Fisher syndrome (MFS) and Guillain-Barre syndrome (GBS) overlap syndrome. Although some features of the patient's presentation were typical of recently reported cases of a rare GBS variant post-Oxford-AstraZeneca vaccination, including severe facial weakness and a lack of respiratory involvement, to our knowledge this is the first reported case of MFS associated with SARS-CoV2 vaccination. While postvaccination GBS remains rare, it appears to have a favourable prognosis, and recognising this entity is therefore important for patient counselling and monitoring for potential complications.

Keywords: COVID-19; cranial nerves; neurology; peripheral nerve disease.

Publication types

  • Case Reports

MeSH terms

  • COVID-19 Vaccines
  • COVID-19*
  • Guillain-Barre Syndrome* / chemically induced
  • Guillain-Barre Syndrome* / diagnosis
  • Humans
  • Miller Fisher Syndrome* / chemically induced
  • Miller Fisher Syndrome* / diagnosis
  • RNA, Viral
  • SARS-CoV-2
  • Vaccination


  • COVID-19 Vaccines
  • RNA, Viral