Miller fisher syndrome (MFS) could be found in coincidence with ossification of posterior longitudinal ligament. High index of suspicion is required that lead to further investigation.

A 56-year-old male presented with four days history of loss of sensation on both lower and upper extremity. The complaint was felt more on the lower than upper extremity. The patient felt imbalance during walking. Muscle strengh of all extremity was normal, but sensory lost was found in all extremity. Deep tendon reflexes were absent in all extremity.

Computed tomography (CT) scan and MRI showed canal stenosis due to of the posterior longitudinal ligament. Nerve conduction velocity suggested peripheral neuropathy on both upper and lower extremity. Antibody anti GQ1b was positive. Cerebrospinal fluid examination showed cytoalbuminemic dissociation.

Patient was treated conservatively.

Improvement was achieved in 5 days, and progressively return to normal condition.

Peripheral polineuropathy could be found in coincident with of the posterior longitudinal ligament and required specific management.

Cahyadi A, Singh A, Ramani PS, Babhulkar S, Pawar S, Shenoy A. Concurrent Miller Fisher Syndrome Variant in Ossification of Posterior Longitudinal Ligament. J Spinal Surg 2014;1(1):32-34.