We report three cases of ciguatera fish poisoning. One Patient died secondary to respiratory failure. Two Patients showed elevated muscle enzymes and one Patients had an abnormal cervical spinal MRI. MRI findings have not been previously described. MRI findings explain the mechanism of the L'hermitte phenomenon (a common complaint) among these Patients. Respiratory failure is rare in ciguatera fish poisoning. Our findings suggest this could be related to respiratory muscles involvement.