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Table 1 Timeline of events with diagnostic tests and interventions

From: Miller Fisher syndrome developing as a parainfectious manifestation of dengue fever: a case report and review of the literature

Day of illness Events Diagnostic tests Interventions
01 Onset of fever   
02 Right ptosis and dysarthria   
03 Bilateral asymmetric ptosis, complete ophthalmoplegia, mid-dilated pupils, swallowing difficulty due to palatal palsy, tongue deviation to right side, ataxia, and areflexia Dengue NS-1 antigen positive
Dengue RT-PCR positive
Admission to hospital, monitoring and fluid management for dengue fever
04   Non-contrast CT (brain) – normal Intravenously administered polyclonal immunoglobulin started, supportive therapy
06 Improvement of ophthalmoplegia and ptosis, resolution of fever MRI (brain) – normal
Nerve conduction studies – evidence of mild axonal polyneuropathy
 
07   Dengue immunoglobulin M (serum) – positive  
08 Improvement of ataxia, ability to walk without support   Intravenously administered polyclonal immunoglobulin (5 days) completed
12   CSF studies – pus cells – nil, lymphocytes 2/μl, protein 20 mg/dl, sugar 80 mg/dl (random blood sugar 131 mg/dl)  
13    Discharged from ward
20 Clinic review – complete neurological resolution   Discharged from clinic
  1. CSF cerebrospinal fluid, CT computed tomography, MRI magnetic resonance imaging, NS-1 non-structural protein 1, RT-PCR reverse transcriptase-polymerase chain reaction