Acute Complex Neuroplegia and Ophthalmoplegia Associated with Anti-GQ1b Antibodies

A 24-year-old gentleman presented with a history of severe throbbing headache preceded by sore throat. He was noted to have a nasal twang and dysphagia. He progressively developed weakness of all four limbs associated with ophthalmoplegia. He, subsequently, had to be intubated and ventilated in view of the involvement of the respiratory muscles. His anti-GQ1b antibodies were positive and the diagnosis of Bickerstaff brainstem encephalitis associated with Miller Fisher Syndrome overlapping with GuillainBarre syndrome was confirmed. He was treated with intravenous Immunoglobulins 0.4 gm/kg/day for 5 days which resulted in a gradual recovery from his neurologic weakness.