Vol 45, No 3 (2011)

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Total ocular akinesis: Miller Fisher or Guillain-Barré syndrome?

Kinga Rajska1, Jacek Rożniecki2, Piotr Loba3, Małgorzata Zielińska2, Anna Broniarczyk-Loba1
DOI: 10.1016/S0028-3843(14)60083-9
Neurol Neurochir Pol 2011;45(3):297-300.


Total, bilateral ophthalmoplegia is very rare. More than 50% of cases are Miller Fisher (MFS) and Guillain-Barré (GBS) syndromes. There is a correlation of MFS with anti-GQ1b antibodies. High levels of GQ1b gangliosides are found in myelin sheathes of cranial nerves supplying the extraocular muscles. This may explain the association of anti-GQ1b antibodies with ophthalmoplegia. Anti-GQ1b were also found in cases of GBS accompanied by ophthalmoplegia, atypical MFS (MFS without ataxia), MFS/GBS overlap syndromes and Bickerstaff brainstem encephalitis. This has led some authors to classify them as ‘anti-GQ1b syndromes’.

In this article we describe a diagnostically difficult case of a patient with a very rare, total bilateral paralysis of all ocular muscles, accompanied by bilateral ptosis, diminished tendon reflexes of upper extremities, paresis and hypoesthesia of the left upper extremity.

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Neurologia i Neurochirurgia Polska