Total internal and external ophthalmoplegia as presenting symptoms of Miller Fisher syndrome.
نویسنده
چکیده
To cite: Man BL. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014205554 DESCRIPTION A 46-year-old woman, who enjoyed good past health, presented with progressive diplopia and unsteady gait after a recent upper respiratory tract infection. She had no fever and denied use of any cycloplegic drugs. Physical examination showed bilateral ptosis (figure 1), and total external (video 1) and internal ophthalmoplegia (video 2). She had bilateral facial weakness and ataxia of limbs. Her limb power was full and there was generalised hyporeflexia. Cerebrospinal fluid examinations showed white cell count <1/mm (<5), protein 0.28 g/L (0.15–0.4), glucose 4.3 mmol/L (2.2–3.9). Serum anti-GQ1b IgM and IgG were strongly positive. MRI of the brain and whole spine were normal. NCT and EEG were normal. She was diagnosed to have Miller Fisher syndrome and was treated with a course of intravenous immunoglobulin. Her ophthalmoplegia improved markedly after treatment. The GQ1b ganglioside is highly enriched in oculomotor, trochlear and abducens nerves, and the ciliary ganglia. Postganglionic involvement of the parasympathetic nerve is associated with internal ophthalmoplegia in anti-GQ1b antibody syndrome. Internal and external ophthalmoplegia is common in anti-GQ1b antibody syndrome and it should be considered in the differential diagnosis of acute or subacute ophthalmoplegia to allow prompt diagnosis and treatment.
منابع مشابه
[Miller Fisher syndrome, internal and external ophthalmoplegia after flu vaccination].
CASE REPORT Miller Fisher Syndrome (MFS) is the most frequent variant of the Guillain-Barré Syndrome. It is characterised by the classic triad of ophthalmoplegia, ataxia and areflexia. We present a case of a patient who developed these clinical findings 5 days after flu vaccination. DISCUSSION Miller Fisher Syndrome is an unusual condition seen in ophthalmologic clinical practice. Although re...
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Miller Fisher Syndrome (MFS) is an acquired disease of nervous system which is considered as a rare variant of Guillain-Barré Syndrome (GBS). Collier first described in 1932 as a variant of the Guillain-Barre syndrome with the triad of ataxia, areflexia and ophthalmoplegia. Charles Miller Fisher in 1956 described 3 patients with the symptoms of sluggish pupillary reflexes, acute external ophtha...
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Miller Fisher syndrome is a variant of Guillain-Barre syndrome characterized by the classic triad of ophthalmoplegia, ataxia, and areflexia. Pupillary involvement is common in MFS and has been reported in 35-42% of MFS patients. Although case reports have discussed isolated ophthalmoplegia as a presentation of MFS, anisocoria and rapid fluctuation of pupillary diameter have not been reported in...
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BACKGROUND A description of the diagnostic features of Miller Fisher syndrome. CASE PRESENTATION The clinical presentation, investigation, and subsequent progress of our patient with clinical unilateral external ophthalmoplegia. CONCLUSION Our case demonstrates the presentation of clinical unilateral external ophthalmoplegia as part of the full triad of Miller Fisher syndrome.
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ورودعنوان ژورنال:
- BMJ case reports
دوره 2014 شماره
صفحات -
تاریخ انتشار 2014