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Total ocular akinesis: Miller Fisher or Guillain-Barré syndrome?
Affiliations- Zakład Patofizjologii Widzenia Obuocznego i Leczenia Zeza I Katedry Chorób Oczu, Uniwersytet Medyczny w Łodzi
- II Klinika Neurologii, Instytut Psychiatrii i Neurologii w Warszawie
- Klinika Chorób Oczu I Katedry Chorób Oczu, Uniwersytet Medyczny w Łodzi
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Abstract
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.
Abstract
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.
Keywords
ophthalmoplegia, Miller Fisher syndrome, Guillain-Barré syndrome
About this articleTitle
Total ocular akinesis: Miller Fisher or Guillain-Barré syndrome?
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
297-300
Page views
576
Article views/downloads
886
DOI
10.1016/S0028-3843(14)60083-9
Bibliographic record
Neurol Neurochir Pol 2011;45(3):297-300.
Keywords
ophthalmoplegia
Miller Fisher syndrome
Guillain-Barré syndrome
Authors
Kinga Rajska
Jacek Rożniecki
Piotr Loba
Małgorzata Zielińska
Anna Broniarczyk-Loba
