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Bellanti R, Rinaldi S. Guillain-Barré syndrome: a comprehensive review. Eur J Neurol 2024; 31:e16365. [PMID: 38813755 PMCID: PMC11235944 DOI: 10.1111/ene.16365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024]
Abstract
Guillain-Barré syndrome (GBS) is a potentially devastating yet treatable disorder. A classically postinfectious, immune-mediated, monophasic polyradiculoneuropathy, it is the leading global cause of acquired neuromuscular paralysis. In most cases, the immunopathological process driving nerve injury is ill-defined. Diagnosis of GBS relies on clinical features, supported by laboratory findings and electrophysiology. Although previously divided into primary demyelinating or axonal variants, this dichotomy is increasingly challenged, and is not endorsed by the recent European Academy of Neurology (EAN)/Peripheral Nerve Society (PNS) guidelines. Intravenous immunoglobulin and plasma exchange remain the primary modalities of treatment, regardless of the electrophysiological subtype. Most patients recover, but approximately one-third require mechanical ventilation, and 5% die. Disease activity and treatment response are currently monitored through interval neurological examination and outcome measures, and the potential role of fluid biomarkers is under ongoing scrutiny. Novel potential therapies for GBS are being explored but none have yet modified clinical practice. This review provides a comprehensive update on the pathological and clinical aspects of GBS for clinicians and scientists.
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Affiliation(s)
- Roberto Bellanti
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Simon Rinaldi
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
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Noioso CM, Bevilacqua L, Acerra GM, Valle PD, Serio M, Pecoraro A, Rienzo A, De Marca U, De Biasi G, Vinciguerra C, Piscosquito G, Toriello A, Tozza S, Barone P, Iovino A. The spectrum of anti-GQ1B antibody syndrome: beyond Miller Fisher syndrome and Bickerstaff brainstem encephalitis. Neurol Sci 2024:10.1007/s10072-024-07686-3. [PMID: 38987510 DOI: 10.1007/s10072-024-07686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Since the initial identification of Miller Fisher syndrome (MFS) and Bickerstaff brainstem encephalitis (BBE),significant milestones have been achieved in understanding these diseases.Discoveries of common serum antibodies (IgG anti-GQ1b), antecedent infections, neurophysiological data, andneuroimaging suggested a shared autoimmune pathogenetic mechanism rather than distinct pathogenesis, leadingto the hypothesis that both diseases are part of a unified syndrome, termed "Fisher-Bickerstaff syndrome". The subsequent identification of atypical anti-GQ1b-positive forms expanded the classification to a broader condition known as "Anti-GQ1b-Antibody syndrome". METHODS An exhaustive literature review was conducted, analyzing a substantial body of research spanning from the initialdescriptions of the syndrome's components to recent developments in diagnostic classification and researchperspectives. RESULTS Anti-GQ1b syndrome encompasses a continuous spectrum of conditions defined by a common serological profilewith varying degrees of peripheral (PNS) and central nervous system (CNS) involvement. MFS and BBE represent theopposite ends of this spectrum, with MFS primarily affecting the PNS and BBE predominantly involving the CNS.Recently identified atypical forms, such as acute ophthalmoparesis, acute ataxic neuropathy withoutophthalmoparesis, Guillain-Barré syndrome (GBS) with ophthalmoparesis, MFS-GBS and BBE-GBS overlap syndromes,have broadened this spectrum. CONCLUSION This work aims to provide an extensive, detailed, and updated overview of all aspects of the anti-GQ1b syndromewith the intention of serving as a stepping stone for further shaping thereof. Special attention was given to therecently identified atypical forms, underscoring their significance in redefining the boundaries of the syndrome.
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Affiliation(s)
- Ciro Maria Noioso
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy.
| | - Liliana Bevilacqua
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Gabriella Maria Acerra
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Paola Della Valle
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Marina Serio
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Agnese Pecoraro
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Annalisa Rienzo
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Umberto De Marca
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Giuseppe De Biasi
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Claudia Vinciguerra
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Giuseppe Piscosquito
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Antonella Toriello
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Stefano Tozza
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Paolo Barone
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Aniello Iovino
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
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Lee SU, Kim HJ, Choi JY, Choi KD, Kim JS. Expanding Clinical Spectrum of Anti-GQ1b Antibody Syndrome: A Review. JAMA Neurol 2024; 81:762-770. [PMID: 38739407 DOI: 10.1001/jamaneurol.2024.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Importance The discovery of the anti-GQ1b antibody has expanded the nosology of classic Miller Fisher syndrome to include Bickerstaff brainstem encephalitis, Guillain-Barré syndrome with ophthalmoplegia, and acute ophthalmoplegia without ataxia, which have been brought under the umbrella term anti-GQ1b antibody syndrome. It seems timely to define the phenotypes of anti-GQ1b antibody syndrome for the proper diagnosis of this syndrome with diverse clinical presentations. This review summarizes these syndromes and introduces recently identified subtypes. Observations Although ophthalmoplegia is a hallmark of anti-GQ1b antibody syndrome, recent studies have identified this antibody in patients with acute vestibular syndrome, optic neuropathy with disc swelling, and acute sensory ataxic neuropathy of atypical presentation. Ophthalmoplegia associated with anti-GQ1b antibody positivity is complete in more than half of the patients but may be monocular or comitant. The prognosis is mostly favorable; however, approximately 14% of patients experience relapse. Conclusions and Relevance Anti-GQ1b antibody syndrome may present diverse neurological manifestations, including ophthalmoplegia, ataxia, areflexia, central or peripheral vestibulopathy, and optic neuropathy. Understanding the wide clinical spectrum may aid in the differentiation and management of immune-mediated neuropathies with multiple presentations.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Hyo-Jung Kim
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Deparment of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Pusan, South Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Deparment of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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Habib AA, Waheed W. Guillain-Barré Syndrome. Continuum (Minneap Minn) 2023; 29:1327-1356. [PMID: 37851033 DOI: 10.1212/con.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article summarizes the clinical features, diagnostic criteria, differential diagnosis, pathogenesis, and prognosis of Guillain-Barré syndrome (GBS), with insights into the current and future diagnostic and therapeutic interventions for this neuromuscular syndrome. LATEST DEVELOPMENTS GBS is an acute, inflammatory, immune-mediated polyradiculoneuropathy that encompasses many clinical variants and divergent pathogenic mechanisms that lead to axonal, demyelinating, or mixed findings on electrodiagnostic studies. The type of antecedent infection, the development of pathogenic cross-reactive antibodies via molecular mimicry, and the location of the target gangliosides affect the subtype and severity of the illness. The data from the International GBS Outcome Study have highlighted regional variances, provided new and internationally validated prognosis tools that are beneficial for counseling, and introduced a platform for discussion of GBS-related open questions. New research has been undertaken, including research on novel diagnostic and therapeutic biomarkers, which may lead to new therapies. ESSENTIAL POINTS GBS is among the most frequent life-threatening neuromuscular emergencies in the world. At least 20% of patients with GBS have a poor prognosis and significant residual deficits despite receiving available treatments. Research is ongoing to further understand the pathogenesis of the disorder, find new biomarkers, and develop more effective and specific treatments.
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Zhang L, Ma L, Zhou L, Sun L, Han C, Fang Q. Miller-Fisher syndrome with positive anti-GD1b and anti-GM1 antibodies combined with multiple autoimmune antibodies: A case report. Medicine (Baltimore) 2023; 102:e34969. [PMID: 37653808 PMCID: PMC10470702 DOI: 10.1097/md.0000000000034969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
RATIONALE Anti-ganglioside antibodies (AGA) play an essential role in the development of Miller-Fisher syndrome (MFS). The positive rate of ganglioside antibodies was exceptionally high in MFS, especially anti-GQ1b antibodies. However, the presence of other ganglioside antibodies does not exclude MFS. PATIENT CONCERNS We present a 48-year-old male patient who suddenly developed dizziness, visual rotation, nausea, and vomiting accompanied by unsteady gait and diplopia for 3 days before presentation to our clinic. DIAGNOSES On physical examination, the patient's right eye could not fully move to the right side and horizontal nystagmus was found. Coordination was also impaired in the upper and lower extremities with dysmetria and dysdiadochokinesia. The electromyography and cerebrospinal fluid examination results were normal. The serum anti-GQlb antibody test results were negative. However, serum anti-GD1b IgM and anti-GM1 IgM antibodies were positive. Meanwhile, the anti-thyroid peroxidase antibody was >600.00 IU/mL (0.00-34.00), and the anti-SS-A/Ro52 antibody was positive. He was diagnosed with MFS. INTERVENTIONS The patient received IVIg treatment for 5 days (0.4 g/kg/day) from day 2 to day 6 of hospitalization. On the 7th day of admission, the patient was administered intravenous methylprednisolone (500 mg/day), which was gradually reduced. OUTCOMES The patient's symptoms improved after treatment with immunoglobulins and hormones. LESSONS We report a case of MFS with positive anti-GD1b and anti-GM1 antibodies combined with multiple autoimmune antibodies. Positive ganglioside antibodies may be used as supporting evidence for the diagnosis; however, the diagnosis of MFS is more dependent on clinical symptoms.
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Affiliation(s)
- Limei Zhang
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Linqing Ma
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Lihua Zhou
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Lu Sun
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Chunru Han
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Qi Fang
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Yvon C, Nee D, Chan D, Malhotra R. Ophthalmoplegia associated with anti-GQ1b antibodies: case report and review. Orbit 2023; 42:192-195. [PMID: 34493154 DOI: 10.1080/01676830.2021.1974495] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 60-year-old man with longstanding bilateral asymmetrical ptosis presented with a partial third nerve palsy. His diplopia improved following an ice pack test. He did not report any symptoms related to the coronavirus disease 2019 (COVID-19), and nasopharyngeal swab was negative. Initial head imaging and blood work-up were normal except for a high titer of anti-GQ1b antibodies. The patient was subsequently diagnosed with acute ophthalmoparesis without ataxia which is part of the anti-GQ1b antibody syndrome spectrum. He made a spontaneous recovery over the following months without the need for immunotherapy. Clinical features, pathophysiology and a review of the literature are discussed herein. It is important to consider anti-GQ1b antibody syndrome in patients with symptoms of diplopia, ptosis or suspected ocular myasthenia.
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Affiliation(s)
- Camille Yvon
- Corneoplastics Unit, Queen Victoria Hospital NHS Trust, East Grinstead, UK
| | - Dominic Nee
- Neurology Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Dennis Chan
- Neurology Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Raman Malhotra
- Corneoplastics Unit, Queen Victoria Hospital NHS Trust, East Grinstead, UK
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Lee SU, Baek SH, Kim HJ, Choi JY, Kim BJ, Kim JS. Acute comitant strabismus in anti-GQ1b antibody syndrome. J Neurol 2023; 270:486-492. [PMID: 36175671 DOI: 10.1007/s00415-022-11394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 01/07/2023]
Abstract
Ophthalmoplegia is the diagnostic hallmark of anti-GQ1b antibody syndrome. This study aimed to define the patterns of acute comitant strabismus in patients with anti-GQ1b antibody syndromes. We retrospectively analyzed the ocular motor findings in 84 patients with anti-GQ1b antibody-associated ophthalmoplegia during the acute phases. Of the 84 patients, 11 (13%) showed acute comitant strabismus. Compared to those without, patients with acute comitant strabismus frequently showed abnormal ocular motor findings that included gaze-evoked (n = 8), spontaneous (n = 4) and positional nystagmus (n = 4), saccadic hypermetria (n = 3), head-shaking nystagmus (n = 2), pulse-step mismatch (n = 1), and impaired visual cancellation of the vestibulo-ocular reflex (n = 1, p < 0.001). On the contrary, iridoplegia (p = 0.029) and ptosis (p = 0.001) were more commonly observed in patients with paralytic (incomitant) strabismus than in those with acute comitant strabismus. Comitant strabismus can manifest during the acute phase of anti-GQ1b antibody syndromes in association with other central ocular motor abnormalities. These findings implicate that the cerebellum and/or brainstem can be the primary target of the anti-GQ1b antibodies.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea.,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.,BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea. .,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.
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8
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Update on the medial longitudinal fasciculus syndrome. Neurol Sci 2022; 43:3533-3540. [DOI: 10.1007/s10072-022-05967-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
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9
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Acute eye movement-retained internal ophthalmoplegia in atypical Miller Fisher syndrome variants are associated with IgG anti-GQ1b antibodies. J Neuroimmunol 2022; 368:577880. [DOI: 10.1016/j.jneuroim.2022.577880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022]
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10
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Ghani MR, Yousaf MIK, Van Bussum K, Shi P, Cordoves Feria RM, Brown M. Miller Fisher Syndrome Presenting Without Areflexia, Ophthalmoplegia, and Albuminocytological Dissociation: A Case Report. Cureus 2022; 14:e23371. [PMID: 35475055 PMCID: PMC9018960 DOI: 10.7759/cureus.23371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS) with a prevalence of one to two people per million each year. Viral and/or bacterial infection often precedes the classic triad of areflexia, ophthalmoplegia, and ataxia. Bulbar involvement is uncommon but can lead to extensive workup to rule out stroke, myasthenia gravis (MG), and other neuromuscular disorders. We present a case of a 32-year-old healthy male with a past medical history of Lyme disease as a teenager and sore throat two weeks prior. He presented to the hospital with rapidly ascending paresthesias in bilateral upper and lower extremities, urinary incontinence, and mild slurred speech. Exam on presentation revealed mild dysmetria in bilateral upper and lower limbs. The remainder of the exam was negative. Neuroradiological imaging, including magnetic resonance imaging (MRI) with and without contrast of the brain and the cervical and lumbar spine, did not show any acute process or abnormal enhancement. Lumbar puncture revealed cerebrospinal fluid (CSF) with normal protein and cell count, and hence no albuminocytological dissociation (ACD). Immunoserology was positive for Epstein-Barr virus (EBV) immunoglobulin G (IgG) but negative for immunoglobulin M (IgM). Despite the absent ACD, areflexia, and no third, fourth, and sixth cranial nerve deficits, there was high suspicion for GBS due to acutely rapid ascending paresthesia, mild dysarthria, and mild ataxia. The patient was started on intravenous immunoglobulin (IVIG) 2 mg/kg divided into five days within 24 hours of admission. The patient developed areflexia in all limbs on the second day of admission and complained of double vision. On the third day of admission, the patient's negative respiratory force (NIF) declined to −23, and he was intubated for airway protection. Our patient completed five days of IVIG. Positive anti-GQ1b antibodies further supported the diagnosis of MFS. After a seven-day ICU stay and 20 days of aggressive inpatient rehabilitation, the patient could do most of the activities of daily living independently. After six weeks, he was back to his normal baseline and restarted his job.
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Gulati S, Badal S, Jauhari P, Singh S, Kamilla G, Chakrabarty B. Acute Isolated External Ophthalmoplegia: Think of Anti-GQ1b Antibody Syndrome. Neurol India 2022; 70:2159-2162. [DOI: 10.4103/0028-3886.359274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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El-Abassi RN, Soliman M, Levy MH, England JD. Treatment and Management of Autoimmune Neuropathies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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13
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Abičić A, Adamec I, Habek M. Miller Fisher syndrome following Pfizer COVID-19 vaccine. Neurol Sci 2021; 43:1495-1497. [PMID: 34817727 PMCID: PMC8611397 DOI: 10.1007/s10072-021-05776-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022]
Abstract
Introduction Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome characterized by ataxia, areflexia, and ophthalmoplegia. We present a case of MFS following Pfizer COVID-19 vaccine. Case presentation A previously healthy 24-year-old female presented with binocular horizontal diplopia 18 days after receiving the first dose of Pfizer COVID-19 vaccine (Comirnaty®). Anti-ganglioside testing revealed positive anti-GQ1b antibodies. Intravenous immunoglobulins were administered, in a dose of 2 g per kg of body weight over 5 days. On a follow-up exam 3 weeks after the treatment, clinical improvement was noted with normal bulbomotor examination. Conclusion Patients with acute ophthalmoplegia occurring after COVID-19 vaccination should be screened for the presence of anti-GQ1b antibody. If the antibody is present, intravenous immunoglobulin should be administered as it may hasten clinical improvement. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05776-0.
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Affiliation(s)
| | - Ivan Adamec
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.
| | - Mario Habek
- Department of Neurology, University Hospital Center Zagreb, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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14
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Kubota T, Hasegawa T, Ikeda K, Aoki M. Case Report: Isolated, unilateral oculomotor palsy with anti-GQ1b antibody following COVID-19 vaccination. F1000Res 2021; 10:1142. [PMID: 35444796 PMCID: PMC8990240 DOI: 10.12688/f1000research.74299.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 12/17/2023] Open
Abstract
Neurological complications following vaccinations are extremely rare, but cannot be eliminated. Here, we report the first case of unilateral oculomotor nerve palsy (ONP) with anti-GQ1b antibody after receiving the Pfizer-BioNTech COVID-19 (BNT162b2) mRNA vaccine. A 65-year-old man developed diplopia and ptosis in the right eye 17 days after vaccination, without preceding infection. Neurological examination revealed mild blepharoptosis, limitation of adduction, and vertical gaze on the right side. Increased levels of anti-GQ1b ganglioside antibody in the serum and albuminocytologic dissociation in the cerebrospinal fluid were detected. Cranial magnetic resonance imaging showed swelling and enhancement of the right oculomotor nerve. The patient was diagnosed with right ONP accompanied with anti-GQ1b antibody, and intravenous immunoglobulin (IVIG) therapy for 5 days was administered. The limitation of adduction and vertical gaze improved, and ptosis markedly resolved after IVIG treatment. Given the temporal sequence of disease progression, laboratory findings, and a favorable response to IVIG, a causal relationship cannot be ruled out between the occurrence of ONP and COVID-19 immunization. Since immunomodulatory treatments significantly hasten the recovery and minimize the residual symptoms in anti-GQ1b antibody syndrome, clinicians should be aware of this clinical condition following COVID-19 vaccination.
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Affiliation(s)
- Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Kensuke Ikeda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
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15
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Kubota T, Hasegawa T, Ikeda K, Aoki M. Case Report: Isolated, unilateral oculomotor palsy with anti-GQ1b antibody following COVID-19 vaccination. F1000Res 2021; 10:1142. [PMID: 35444796 PMCID: PMC8990240 DOI: 10.12688/f1000research.74299.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/20/2022] Open
Abstract
Neurological complications following vaccinations are extremely rare, but cannot be eliminated. Here, we report the first case of unilateral oculomotor nerve palsy (ONP) with anti-GQ1b antibody after receiving the Pfizer-BioNTech COVID-19 (BNT162b2) mRNA vaccine. A 65-year-old man developed diplopia and ptosis in the right eye 17 days after vaccination, without preceding infection. Neurological examination revealed mild blepharoptosis, limitation of adduction, and vertical gaze on the right side. Increased levels of anti-GQ1b ganglioside antibody in the serum and albuminocytologic dissociation in the cerebrospinal fluid were detected. Cranial magnetic resonance imaging showed swelling and enhancement of the right oculomotor nerve. The patient was diagnosed with right ONP accompanied with anti-GQ1b antibody, and intravenous immunoglobulin (IVIG) therapy for 5 days was administered. The limitation of adduction and vertical gaze improved, and ptosis markedly resolved after IVIG treatment. Given the temporal sequence of disease progression, laboratory findings, and a favorable response to IVIG, a causal relationship cannot be ruled out between the occurrence of ONP and COVID-19 immunization. Since immunomodulatory treatments significantly hasten the recovery and minimize the residual symptoms in anti-GQ1b antibody syndrome, clinicians should be aware of this clinical condition following COVID-19 vaccination.
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Affiliation(s)
- Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Kensuke Ikeda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
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Ravlic MM, Knezevic L, Krolo I, Herman JS. Ocular Manifestations of Miller Fisher Syndrome: a Case Report. Med Arch 2021; 75:234-236. [PMID: 34483456 PMCID: PMC8385741 DOI: 10.5455/medarh.2021.75.234-236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Miller Fisher syndrome (MFS) is a variant of Guillain-Barré syndrome and is characterised by a clinical triad of ophthalmoplegia, ataxia and areflexia. Objectives: This report presents an atypical case of MFS characterized by ocular and gastrointestinal involvement, and anti-ganglioside antibody-positivity. Methods: A 17-year old boy was referred to our ophthalmology emergency room with signs and symptoms of diplopia and upper lid ptosis of the right eye. He underwent a complete ophthalmologic examination with special reference to strabologic status, as well as a neuropediatric examination with serum antiganglioside antibody panel. Results: Strabologic examination showed horisontal diplopia (near and far), ptosis of the upper eyelid on the right and bilateral ophthalmoplegia (limited elevation). Orthoptic examination revealed esotropia of 8 prism dioptres (PD) at near and 18 PD at far distance. A pediatric neurologist found normal limb power, deep tendon reflexes and flexor plantar responses, but attenuated right patellar reflex. Serum anti-GQ1b IgG (+++), anti-GQ1b IgM (++) and anti-GD1a IgM(++) were positive. Positivity of anti-GQ1b IgG antibody confirmed the existence of incomplete MFS. We treated the patient with systemic intravenous immunoglobulins for five days, and after five months of follow-up, all symptoms resolved. Conclusion: MFS can present itself as a wide range of clinical features and its timely recognition is important. Despite the alarming nature of the disease, patients with MFS tend to have a good recovery of presented symptoms, and without any significant residual deficit.
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Affiliation(s)
- Maja Malenica Ravlic
- Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Lana Knezevic
- Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Iva Krolo
- Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
| | - Jelena Skunca Herman
- Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
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17
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Kim BY, Yung Y, Kim GS, Park HR, Lee JJ, Song P, Cho JY. Complete Oculomotor Palsy after Influenza Vaccination in a Young Healthy Adult: A Case Report. Case Rep Neurol 2021; 13:35-39. [PMID: 33613242 PMCID: PMC7879276 DOI: 10.1159/000511025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022] Open
Abstract
Influenza vaccines are known to have a few neurological complications, such as Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, and acute disseminated encephalomyelitis. However, oculomotor palsy caused by influenza vaccination is extremely rare. We present a case report of a 25-year-old woman without any medical history who developed complete oculomotor palsy 2 weeks after influenza vaccination. Other possible causes of oculomotor nerve palsy, such as stroke, compressive lesions, infections, and autoimmune disorders, were eliminated by blood tests, cerebrospinal fluid examination, and imaging studies. Hence, influenza vaccine was considered as the likely cause.
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Affiliation(s)
- Bo Young Kim
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Youngbok Yung
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Geun Soo Kim
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Hea Ree Park
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Jae Jung Lee
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Pamela Song
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Joong-Yang Cho
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Republic of Korea
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18
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Yoon BA, Ha DH, Park HT, Kusunoki S, Kuwahara M, Lee JH, Bae JS, Kim JK. Finger drop sign as a new variant of acute motor axonal neuropathy. Muscle Nerve 2020; 63:336-343. [PMID: 33217007 DOI: 10.1002/mus.27126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
We propose the finger drop sign as a new clinical variant of acute motor axonal neuropathy (AMAN) defined by immunological and radiological evidence. We identified eight consecutive patients who had AMAN. All of them developed prominent involvement of the finger extensors. We performed magnetic resonance imaging (MRI) of the extremity muscles and serological assays for antiganglioside antibodies and Campylobacter jejuni. Patients with AMAN showed characteristic and a markedly sustained weakness of the finger extensors with a distinctive pattern of the finger drop sign. Limb MRI revealed unevenly distributed abnormal signals in the muscles mainly innervated by the posterior interosseous nerve. All tested patients showed positivity for immunoglobulin G antibody against ganglioside complex of GM1 and phosphatidic acid. A pathophysiological understanding of this unique syndrome can provide further insight into antiganglioside-antibody-mediated axonal injury in Guillain-Barré syndrome.
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Affiliation(s)
- Byeol-A Yoon
- Department of Neurology, Dong-A University College of Medicine, Busan, Republic of Korea.,Department of Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Dong-Ho Ha
- Department of Radiology, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Hwan Tae Park
- Department of Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Republic of Korea.,Department of Molecular Neuroscience, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Susumu Kusunoki
- Department of Neurology, Kindai University College of Medicine, Osaka, Japan
| | - Motoi Kuwahara
- Department of Neurology, Kindai University College of Medicine, Osaka, Japan
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Republic of Korea.,Department of Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Republic of Korea
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19
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Rodrigo-Rey S, Gutiérrez-Ortiz C, Muñoz S, Ortiz-Castillo JV, Siatkowski RM. What did he eat? Surv Ophthalmol 2020; 66:892-896. [PMID: 33010288 PMCID: PMC7526636 DOI: 10.1016/j.survophthal.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 10/28/2022]
Abstract
A 13-year-old boy reported acute horizontal binocular diplopia and headache. Ten days before these symptoms he suffered from a gastrointestinal infection. Ophthalmological examination revealed bilateral ophthalmoparesis and diffuse hyporeflexia. Magnetic resonance imaging of the brain was normal. Lumbar puncture revealed albumin-cytological dissociation. There were no anti-GQ1b antibodies, but serum anti-GM1 antibodies were detected. He received intravenous immunoglobulins and had fully recovered two weeks later. Miller Fisher syndrome and its atypical variants are uncommon in childhood; nevertheless, they should be considered in the differential diagnosis of bilateral acute ophthalmoparesis.
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Affiliation(s)
- Sara Rodrigo-Rey
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Consuelo Gutiérrez-Ortiz
- Glaucoma and Neuro-ophthalmology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - Silvia Muñoz
- Ophthalmology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - R Michael Siatkowski
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
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20
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Du FH, Yerevanian A, Shtrahman M. Acute ophthalmoplegia in a patient with anti-GQ1b antibody and chronic facial diplegia. BMJ Case Rep 2020; 13:13/7/e234319. [DOI: 10.1136/bcr-2020-234319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old man with a remote history of bilateral recurrent facial palsies presented with a week of ophthalmoplegia with intact deep tendon reflexes and lack of ataxia, cerebrospinal fluid with albuminocytologic dissociation and elevated serum anti-ganglioside Q1b (GQ1b) IgG antibody. We diagnosed the patient with acute ophthalmoplegia without ataxia, a condition under the spectrum of anti-GQ1b antibody syndromes which also includes Miller Fisher syndrome. Given the rarity of recurrent facial palsies and anti-GQ1b antibody syndromes as well as reports associating facial palsies and this syndrome, we suggest that our case may be an unusual presentation of an anti-GQ1b antibody syndrome beginning with recurrent facial palsies several years prior to ophthalmoplegia. Prior studies of human nerves provide insight into the pathophysiology, including ganglioside distribution and cross-reactivities underlying the heterogeneity of anti-GQ1b antibody syndromes. This report may expand the differential diagnosis in patients with recurrent facial palsies and broaden the phenotype of anti-GQ1b syndromes.
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21
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Ryu WY, Kim YH, Yoon BA, Park HT, Bae JS, Kim JK. Pattern of Extraocular Muscle Involvements in Miller Fisher Syndrome. J Clin Neurol 2019; 15:308-312. [PMID: 31286701 PMCID: PMC6620438 DOI: 10.3988/jcn.2019.15.3.308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose The most-common initial manifestation of Miller Fisher syndrome (MFS) is diplopia due to acute ophthalmoplegia. However, few studies have focused on ocular motility findings in MFS. This study aimed to determine the pattern of extraocular muscle (EOM) paresis in MFS patients. Methods We consecutively recruited MFS patients who presented with ophthalmoplegia between 2010 and 2015. The involved EOMs and the strabismus pattern in the primary position were analyzed. Antecedent infections, other involved cranial nerves, and laboratory findings were also reviewed. We compared the characteristics of the patients according to the severity of ophthalmoplegia between complete ophthalmoplegia (CO) and incomplete ophthalmoplegia (IO). Results Twenty-five patients (15 males and 10 females) with bilateral ophthalmoplegia were included in the study. The most-involved and last-to-recover EOM was the lateral rectus muscle. CO and IO were observed in 11 and 14 patients, respectively. The patients were aged 59.0±18.4 years (mean±SD) in the CO group and 24.9±7.4 years in the IO group (p<0.01), and comprised 63.6% and 21.4% females, respectively (p=0.049). Elevated cerebrospinal fluid protein was identified in 60.0% of patients with CO and 7.7% of patients with IO (p=0.019) for a mean follow-up time from the initial symptom onset of 3.7 days. Conclusions The lateral rectus muscle is the most-involved and last-to-recover EOM in ophthalmoplegia. The CO patients were much older and were more likely to be female and have an elevation of cerebrospinal fluid protein than the IO patients.
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Affiliation(s)
- Won Yeol Ryu
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Yoo Hwan Kim
- Department of Neurology, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Byeol A Yoon
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea.,Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Korea
| | - Hwan Tae Park
- Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Korea.,Department of Molecular Neuroscience, Dong-A University College of Medicine, Busan, Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea.,Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Korea.
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22
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Choi KD, Choi SY, Choi JH, Kim SH, Lee SH, Jeong SH, Kim HJ, Choi JY, Kim JS. Characteristics of single ocular motor nerve palsy associated with anti-GQ1b antibody. J Neurol 2018; 266:476-479. [PMID: 30556099 DOI: 10.1007/s00415-018-9161-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022]
Abstract
To define the prevalence and characteristics of single ocular motor nerve palsy (OMNP) associated with positive serum anti-GQ1b antibody. We performed a prospective multicenter study that recruited 82 patients with single OMNP without identifiable causes from the history and neuroimaging in six neurology clinics of university hospitals. We measured serum anti-GQ1b antibody in all participants. Twelve patients with multiple OMNP and 30 with identifiable causes served as the controls. Overall, the prevalence of anti-GQ1b antibody syndrome was 10% (8/82) in patients with single OMNP and 6% (5/78) in those with single OMNP in isolation. None of the 14 patients with OMNP with identifiable causes showed positive serum anti-GQ1b antibody. The prevalence of anti-GQ1b antibody syndrome was much higher in patients with multiple OMNP than in those with single OMNP (50% vs. 10%, p < 0.01). Patients with single OMNP and positive anti-GQ1b antibody are younger (42 ± 16 vs. 58 ± 15, p < 0.05) and had a significantly higher frequency of preceding infection (75 vs. 19%, p < 0.05) and other neurological signs (38 vs. 1%, p < 0.05) than those with negative antibody. Eight patients with single OMNP and positive serum anti-GQ1b antibody involved the abducens (n = 6), trochlear (n = 1), or oculomotor nerve (n = 1). Single OMNP accompanying other neurological signs and multiple OMNP are more likely to be associated with anti-GQ1b antibody. Anti-GQ1b antibody syndrome should be considered even in patients with single OMNP, especially when antecedent infection was associated in younger patients.
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Affiliation(s)
- Kwang-Dong Choi
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Seo Young Choi
- Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Jae-Hwan Choi
- Department of Neurology, Biomedical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Seong Hi Kim
- Department of Neurology, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Seong-Han Lee
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Seong-Hae Jeong
- Department of Neurology, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyo-Jung Kim
- Department of Neurology, Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea
| | - Ji-Soo Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea.
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea.
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23
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Moreno-Ajona D, Irimia P, Fernández-Matarrubia M. Headache and Ophthalmoparesis: Case Report of an “Atypical” Incomplete Miller-Fisher Syndrome. Headache 2018; 58:746-749. [DOI: 10.1111/head.13320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 02/08/2018] [Accepted: 02/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Pablo Irimia
- Department of Neurology; Clínica Universidad de Navarra; Pamplona Spain
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24
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Affiliation(s)
- Frederick Bassal
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX
| | - Pamela Lupo
- Department of Pediatrics, Neurology Division, University of Texas Medical Branch, Galveston, TX
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25
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Ueno T, Kon T, Kurihara AI, Tomiyama M. Unilateral Oculomotor Nerve Palsy Following Campylobacter Infection: A Mild Form of Miller Fisher Syndrome without Ataxia. Intern Med 2017; 56:2929-2932. [PMID: 28943568 PMCID: PMC5709641 DOI: 10.2169/internalmedicine.8824-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Unilateral oculomotor nerve palsy can result from various neurological disorders. We herein report the case of a 68-year-old man with complete unilateral oculomotor nerve palsy following campylobacter infection. Based on the antecedent infection and the patient's decreased tendon reflexes, incomplete Miller Fisher syndrome (MFS) without ataxia was suspected. His serum tested positive for anti-GQ1b antibodies. He recovered over a period of 87 days without immunotherapy. We conclude that incomplete MFS following campylobacter infection can cause unilateral oculomotor nerve palsy without ataxia. Mild MFS should be considered in patients presenting with unilateral isolated ophthalmoplegia and decreased tendon reflexes.
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Affiliation(s)
- Tatsuya Ueno
- Department of Neurology, Aomori Prefectural Central Hospital, Japan
| | - Tomoya Kon
- Department of Neurology, Aomori Prefectural Central Hospital, Japan
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26
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Kim JK, Hong SK, Bae JS, Yoon BA, Park HT, Huh SY, Kim SJ, Kim JE, Kim DS. Ophthalmoplegic Guillain-Barré syndrome: An independent entity or a transitional spectrum? J Clin Neurosci 2016; 32:19-23. [PMID: 27436763 DOI: 10.1016/j.jocn.2015.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/05/2015] [Accepted: 11/29/2015] [Indexed: 12/28/2022]
Abstract
Ophthalmoplegia can occur in both Miller Fisher syndrome (MFS) and Guillain-Barré syndrome (GBS) with typical limb involvement. However, ophthalmoplegic GBS (OGBS) has been poorly defined. We aimed to characterize OGBS and clarify the pathophysiological implications across the overall GBS spectrum. Twenty GBS and seven MFS patients from three university based teaching hospitals in Korea were enrolled and analyzed. Six GBS patients who were classified as OGBS commonly also had facial diplegia (50%) and bulbar palsy (50%), while only a small portion of non-ophthalmoplegic GBS (NOGBS) patients had facial diplegia (21%). None of the patients had bulbar palsy in the NOGBS or MFS groups. The most frequent anti-ganglioside antibody in OGBS was the IgG anti-GT1a antibody (50%). The IgG anti-GM1 antibody was found mainly in NOGBS (57%) with high concordance with the pure motor type classification on electrophysiology. IgG anti-GQ1b antibody was positive uniquely in MFS (100%), although some patients were also positive for anti-GT1a antibody (71%). OGBS had distinct clinical features, including bulbar palsy, as well as ophthalmoplegia and limb weakness for both GBS and MFS. Relevant immunological factors were anti-GT1a antibody. Whether OGBS is an independent entity or a transitional spectrum remains to be established and further study will be needed.
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Affiliation(s)
- Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, South Korea
| | - Seuk Kyung Hong
- Department of Neurology, Dong-A University College of Medicine, Busan, South Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Byeol-A Yoon
- Department of Neurology, Dong-A University College of Medicine, Busan, South Korea
| | - Hwan Tae Park
- Department of Physiology, Dong-A University College of Medicine, Busan, South Korea
| | - So Young Huh
- Department of Neurology, Kosin University College of Medicine, Busan, South Korea
| | - Sang-Jin Kim
- Department of Neurology, Inje University College of Medicine, Busan, South Korea
| | - Jong-Eun Kim
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Gyeongsangnam-do, South Korea
| | - Dae-Seong Kim
- Department of Neurology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University, Gyeongsangnam-do, South Korea.
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27
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Zouiri G, Abilkassem R, Zerhouni A, Dini N, Agadr A. Syndrome de Guillain-Barré à reflexes conservés. Arch Pediatr 2016; 23:501-3. [DOI: 10.1016/j.arcped.2016.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/12/2015] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
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28
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Guisset F, Ferreiro C, Voets S, Sellier J, Debaugnies F, Corazza F, Deconinck N, Prigogine C. Anti-GQ1b antibody syndrome presenting as acute isolated bilateral ophthalmoplegia: Report on two patients and review of the literature. Eur J Paediatr Neurol 2016; 20:439-43. [PMID: 26924168 DOI: 10.1016/j.ejpn.2016.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 10/29/2015] [Accepted: 02/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Miller Fisher syndrome (MFS) is an acute polyradiculoneuritis regarded as an uncommon clinical variant of Guillain-Barré syndrome (GBS). MFS is characterized by the acute onset of the clinical triad of ophthalmoplegia, cereballar ataxia and areflexia. Atypical forms of MFS presenting as isolated ophthalmoplegia without ataxia have been rarely described, mostly in adults. PATIENTS We present two cases of acute isolated bilateral ophthalmoplegia in childhood, both occurring shortly after Campylobacter jejuni enteritis. Serum analysis of anti-ganglioside antibodies revealed elevated levels of anti-GQ1b IgG and IgM. We observed in both children complete spontaneous resolution several weeks after onset. CONCLUSION The cases of the two patients confirm the rare but possible occurrence of atypical MFS in young children a few weeks after gastrointestinal infection. Identification of high levels of anti-GQ1b antibodies in the serum may help confirm the diagnosis of MFS even when its clinical presentation is incomplete.
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Affiliation(s)
- François Guisset
- Department of Paediatrics, Centre Hospitalier Universitaire Saint-Pierre (U.L.B.), Rue Haute 322, 1000 Brussels, Belgium.
| | - Christine Ferreiro
- Department of Paediatrics, Centre Hospitalier Universitaire Saint-Pierre (U.L.B.), Rue Haute 322, 1000 Brussels, Belgium
| | - Serge Voets
- Department of Paediatric Neurology, Centre Hospitalier Universitaire Saint-Pierre (U.L.B.), Rue Haute 322, 1000 Brussels, Belgium
| | - Julie Sellier
- Department of Paediatrics, Centre Hospitalier Universitaire Saint-Pierre (U.L.B.), Rue Haute 322, 1000 Brussels, Belgium
| | - France Debaugnies
- Laboratory of Immunology, IRISLab, Centre Hospitalier Universitaire Brugmann (U.L.B.), Place Van Gehuchten 4, 1020 Brussels, Belgium
| | - Francis Corazza
- Laboratory of Immunology, IRISLab, Centre Hospitalier Universitaire Brugmann (U.L.B.), Place Van Gehuchten 4, 1020 Brussels, Belgium
| | - Nicolas Deconinck
- Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (U.L.B.), Avenue Crocq 15, 1020 Brussels, Belgium
| | - Cynthia Prigogine
- Department of Paediatric Neurology, Centre Hospitalier Universitaire Saint-Pierre (U.L.B.), Rue Haute 322, 1000 Brussels, Belgium; Department of Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (U.L.B.), Avenue Crocq 15, 1020 Brussels, Belgium
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29
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Abstract
Peripheral nervous system axons and myelin have unique potential protein, proteolipid, and ganglioside antigenic determinants. Despite the existence of a blood-nerve barrier, both humoral and cellular immunity can be directed against peripheral axons and myelin. Molecular mimicry may be triggered at the systemic level, as was best demonstrated in the case of bacterial oligosaccharides. The classification of immune neuropathy has been expanded to take into account specific syndromes that share unique clinical, electrophysiological, prognostic and serological features. Guillain-Barré syndrome encompasses a classical syndrome of acute demyelinating polyradiculoneuropathy and many variants: axonal motor and sensory, axonal motor, Miller-Fisher, autonomic, and sensory. Similarly, chronic immune neuropathy is composed of classic chronic inflammatory demyelinating polyradiculoneuropathy and variants characterized as multifocal (motor or sensorimotor), sensory, distal symmetric, and syndromes associated with monoclonal gammopathy. Among putative biomarkers, myelin associated glycoprotein and several anti-ganglioside autoantibodies have shown statistically significant associations with specific neuropathic syndromes. Currently, the strongest biomarker associations are those linking Miller-Fisher syndrome with anti-GQ1b, multifocal motor neuropathy with anti-GM1, and distal acquired symmetric neuropathy with anti-MAG antibodies. Many other autoantibody associations have been proposed, but presently lack sufficient specificity and sensitivity to qualify as biomarkers. This field of research has contributed to the antigenic characterization of motor and sensory functional systems, as well as helping to define immune neuropathic syndromes with widely different clinical presentation, prognosis and response to therapy. Serologic biomarkers are likely to become even more relevant with the advent of new targeted forms of immunotherapy, such as monoclonal antibodies.
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30
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Man BL. Total internal and external ophthalmoplegia as presenting symptoms of Miller Fisher syndrome. BMJ Case Rep 2014; 2014:bcr-2014-205554. [PMID: 25121494 DOI: 10.1136/bcr-2014-205554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Bik Ling Man
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong
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Kim JK, Bae JS, Kim DS, Kusunoki S, Kim JE, Kim JS, Park YE, Park KJ, Song HS, Kim SY, Lim JG, Kim NH, Suh BC, Nam TS, Park MS, Choi YC, Sohn EH, Na SJ, Huh SY, Kwon O, Lee SY, Lee SH, Oh SY, Jeong SH, Lee TK, Kim DU. Prevalence of anti-ganglioside antibodies and their clinical correlates with guillain-barré syndrome in Korea: a nationwide multicenter study. J Clin Neurol 2014; 10:94-100. [PMID: 24829594 PMCID: PMC4017025 DOI: 10.3988/jcn.2014.10.2.94] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/05/2013] [Accepted: 10/16/2013] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose No previous studies have investigated the relationship between various anti-ganglioside antibodies and the clinical characteristics of Guillain-Barré syndrome (GBS) in Korea. The aim of this study was to determine the prevalence and types of anti-ganglioside antibodies in Korean GBS patients, and to identify their clinical significance. Methods Serum was collected from patients during the acute phase of GBS at 20 university-based hospitals in Korea. The clinical and laboratory findings were reviewed and compared with the detected types of anti-ganglioside antibody. Results Among 119 patients, 60 were positive for immunoglobulin G (IgG) or immunoglobulin M antibodies against any type of ganglioside (50%). The most frequent type was IgG anti-GM1 antibody (47%), followed by IgG anti-GT1a (38%), IgG anti-GD1a (25%), and IgG anti-GQ1b (8%) antibodies. Anti-GM1-antibody positivity was strongly correlated with the presence of preceding gastrointestinal infection, absence of sensory symptoms or signs, and absence of cranial nerve involvement. Patients with anti-GD1a antibody were younger, predominantly male, and had more facial nerve involvement than the antibody-negative group. Anti-GT1a-antibody positivity was more frequently associated with bulbar weakness and was highly associated with ophthalmoplegia when coupled with the coexisting anti-GQ1b antibody. Despite the presence of clinical features of acute motor axonal neuropathy (AMAN), 68% of anti-GM1- or anti-GD1a-antibody-positive cases of GBS were diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) by a single electrophysiological study. Conclusions Anti-ganglioside antibodies were frequently found in the serum of Korean GBS patients, and each antibody was correlated strongly with the various clinical manifestations. Nevertheless, without an anti-ganglioside antibody assay, in Korea AMAN is frequently misdiagnosed as AIDP by single electrophysiological studies.
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Affiliation(s)
- Jong Kuk Kim
- Department of Neurology, College of Medicine, Dong-A University, Busan, Korea
| | - Jong Seok Bae
- Department of Neurology, College of Medicine, Hallym University, Seoul, Korea
| | - Dae-Seong Kim
- Department of Neurology, School of Medicine, Pusan National University, Busan, Korea
| | - Susumu Kusunoki
- Department of Neurology, School of Medicine, Kinki University, Osaka, Japan
| | - Jong Eun Kim
- Department of Industrial and Occupational Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ji Soo Kim
- Department of Neurology, College of Medicine, Seoul National University, Seoul, Korea
| | - Young-Eun Park
- Department of Neurology, School of Medicine, Pusan National University, Busan, Korea
| | - Ki-Jong Park
- Department of Neurology, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Hyun Seok Song
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sun Young Kim
- Department of Neurology, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Jeong-Geun Lim
- Department of Neurology, School of Medicine, Keimyung University, Daegu, Korea
| | - Nam-Hee Kim
- Department of Neurology, College of Medicine, Dongguk University, Seoul, Korea
| | - Bum Chun Suh
- Department of Neurology, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Tai-Seung Nam
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Min Su Park
- Department of Neurology, School of Medicine, Yeungnam University, Daegu, Korea
| | - Young-Chul Choi
- Department of Neurology, College of Medicine, Yonsei University, Seoul, Korea
| | - Eun Hee Sohn
- Department of Neurology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Sang-Jun Na
- Department of Neurology, College of Medicine, Konyang University, Daejeon, Korea
| | - So Young Huh
- Department of Neurology, College of Medicine, Kosin University, Busan, Korea
| | - Ohyun Kwon
- Department of Neurology, School of Medicine, Eulji University, Seoul, Korea
| | - Su-Yun Lee
- Department of Neurology, College of Medicine, Dong-A University, Busan, Korea
| | - Sung-Hoon Lee
- Department of Neurology, College of Medicine, Hallym University, Seoul, Korea
| | - Sun-Young Oh
- Department of Neurology, School of Medicine, Chonbuk National University, Jeonju, Korea
| | - Seong-Hae Jeong
- Department of Neurology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Tae-Kyeong Lee
- Department of Neurology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Dong Uk Kim
- Department of Neurology, School of Medicine, Chosun University, Gwangju, Korea
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Abstract
We describe the case of an 85-year-old gentleman admitted with bilateral ptosis and complete bilateral ocular paralysis. Initial differential diagnoses included myasthenia gravis, diabetic cranial neuropathy, an ischaemic event and possible occult neoplasm. Investigations did not support any of the differentials and Miller Fisher syndrome (MFS) was considered. Anti-GQ1b IgG antibody was positive, supporting the possibility of anti-ganglioside syndrome. This gentleman was treated with intravenous immunoglobulin (IVIG) and made a full recovery.
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Affiliation(s)
- Daniel John Hall
- Medicine, Calderdale and Huddersfield NHS Foundation Trust, Calderdale Royal Hospital Salterhebble, Halifax, West Yorkshire HX30PW, UK
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Abstract
PURPOSE OF REVIEW Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in children. This review discusses the heterogeneous presentations of this disorder, the frequency of disease-related complications and the importance of assiduous clinical care in pediatric GBS. RECENT FINDINGS Recent reports have highlighted the variable clinical and neurophysiologic subtypes of pediatric GBS, and emphasized the value of imaging in diagnosis of this disorder. SUMMARY Diagnosis of pediatric GBS is often delayed because of its variable presentation. Early recognition and treatment decrease long-term morbidity and mortality. Recent research has cast light on the variable presentations and pathogenesis of the numerous subtypes of this condition, and is now focusing upon a better understanding of the natural history of GBS.
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Abstract
BACKGROUND Guillain-Barré syndrome and myasthenia gravis both lead to muscle weakness but the two combined is uncommon. Detection of these entities can help identify forms of autoimmune neuromuscular diseases that may respond to immunotherapy. This report sought to characterize the clinical features of these two entities when combined. METHODS This report is of a case of combined Guillain-Barré syndrome and myasthenia gravis. The clinical features were analyzed and correlated to those published in English literature from 1960 to 2012. Ten reports and 12 cases, including the present case, were reviewed. RESULTS There were 12 patients (4 women and 8 men), aged 17 to 84 years, with combined Guillain-Barré syndrome and myasthenia gravis. Four had post-infectious Guillain-Barré syndrome followed by the development of myasthenia gravis concurrently or concomitantly within one month. All cases had symptoms of ptosis and areflexia. The other common presentations were limb weakness, oculobulbar weakness, and respiratory involvement. Functional outcome was mentioned in 10 patients and seven had good outcome (Hughes scale ≤ 2). CONCLUSION Detection of ptosis with or without ophthalmoplegia, distribution of limb weakness, and reflex can help in recognizing combined Guillain-Barré syndrome and myasthenia gravis. The early recognition of this combination of peripheral nervous and neuro-muscular junction inflammation is important for initial treatment and prognosis.
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Affiliation(s)
- Meng-Ying Hsieh
- Division of Pediatric Neurology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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35
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Kaymakamzade B, Selcuk F, Koysuren A, Colpak AI, Mut SE, Kansu T. Pupillary Involvement in Miller Fisher Syndrome. Neuroophthalmology 2013; 37:111-115. [PMID: 28163765 DOI: 10.3109/01658107.2013.792356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/03/2013] [Accepted: 03/04/2013] [Indexed: 11/13/2022] Open
Abstract
Miller Fisher Syndrome is characterised by the classical triad of ophthalmoplegia, ataxia, and areflexia. Ophthalmoparesis without ataxia, without areflexia, or with neither have been attributed as atypical forms of MFS. We report two patients with MFS who had tonic pupils and raised anti-GQ1b antibody titres. Bilateral dilated pupils (either tonic or fixed) can be a manifestation of MFS and anti-GQ1b immunoglobulin G (IgG) antibodies are useful to confirm the diagnosis in unexplained cases. The site of involvement is thought to be the ciliary ganglion or short ciliary nerves.
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Affiliation(s)
- Bahar Kaymakamzade
- Department of Neurology, Dr. Burhan Nalbantoglu State Hospital, Nicosia Northern Cyprus Cyprus
| | - Ferda Selcuk
- Department of Neurology, Dr. Burhan Nalbantoglu State Hospital, Nicosia Northern Cyprus Cyprus
| | - Aydan Koysuren
- Department of Neurology, School of Medicine, Hacettepe University Ankara Turkey
| | - Ayse Ilksen Colpak
- Department of Neurology, School of Medicine, Hacettepe University Ankara Turkey
| | - Senem Ertugrul Mut
- Department of Neurology, Dr. Burhan Nalbantoglu State Hospital, Nicosia Northern Cyprus Cyprus
| | - Tulay Kansu
- Department of Neurology, School of Medicine, Hacettepe University Ankara Turkey
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36
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Abstract
PURPOSE.: Miller Fisher syndrome (MFS) is a rare immune-mediated neuropathy that commonly presents with diplopia after the acute onset of complete bilateral external ophthalmoplegia. Ophthalmoplegia is often accompanied by other neurological deficits such as ataxia and areflexia that characterize MFS. Although MFS is a clinical diagnosis, serological confirmation is possible by identifying the anti-GQ1b antibody found in most of the affected patients. We report a patient with MFS who presented with clinical signs suggestive of ocular myasthenia gravis but in whom the correct diagnosis was made on the basis of serological testing for the anti-GQ1b antibody. CASE REPORT.: An 81-year-old white man presented with an acute onset of diplopia after a mild gastrointestinal illness. Clinical examination revealed complete bilateral external ophthalmoplegia and left-sided ptosis. He developed more marked bilateral ptosis, left greater than right, with prolonged attempted upgaze. He was also noted to have a Cogan lid twitch. Same day evaluation by a neuro-ophthalmologist revealed mild left-sided facial and bilateral orbicularis oculi weakness. He had no limb ataxia but exhibited a slightly wide-based gait with difficulty walking heel-to-toe. A provisional diagnosis of ocular myasthenia gravis was made, and anticholinesterase inhibitor therapy was initiated. However, his symptoms did not improve, and serological testing was positive for the anti-GQ1b immunoglobulin G antibody, supporting a diagnosis of MFS. CONCLUSIONS.: Although the predominant ophthalmic feature of MFS is complete bilateral external ophthalmoplegia, it should be recognized that MFS has variable associations with lid and pupillary dysfunction. Such confounding neuro-ophthalmic features require a thorough history, neurological examination, neuroimaging, and serological testing for the anti-GQ1b antibody to arrive at a diagnosis of MFS.
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37
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Isolated bilateral ptosis as an early sign of guillain-barré syndrome. Case Rep Neurol Med 2013; 2013:178291. [PMID: 23585975 PMCID: PMC3621155 DOI: 10.1155/2013/178291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/04/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Guillain-Barré syndrome (GBS) has many variants with distinct presentations. Ptosis as an initial presentation is rare. Case Report. We describe a young female with bilateral ptosis without ophthalmoplegia as the initial presentation of Guillain-Barré ptosis in an anti-GQ1b IgG antibody negative patient with a favorable outcome to intravenous immunoglobulins. Objectives. Our paper highlights the importance of recognizing GBS as a potential etiology in a patient presenting with isolated ptosis, particularly since the course of GBS can be more dramatic than in the anti-GBQ1b syndromes such as ophthalmoparesis without ataxia and Miller Fisher syndrome or ocular myasthenia. Conclusion. This is the first paper of anti-GBQ1b antibody negative GBS presenting with isolated ptosis without ophthalmoparesis. GBS should be included in the list of differential diagnosis of such presentations.
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38
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Teng HW, Sung JY. Ptosis as the Initial Presentation of Guillain-Barré Syndrome. J Emerg Med 2012; 43:e283-5. [DOI: 10.1016/j.jemermed.2010.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 02/27/2010] [Accepted: 05/14/2010] [Indexed: 11/25/2022]
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39
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Choi KD, Choi JH, Choi HY, Huh YE, Kim HJ, Oh SY, Jeong SH, Hwang JM, Kim JS. Inferior rectus palsy as an isolated ocular motor sign: acquired etiologies and outcome. J Neurol 2012; 260:47-54. [PMID: 22743791 DOI: 10.1007/s00415-012-6582-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/07/2012] [Accepted: 06/09/2012] [Indexed: 11/26/2022]
Abstract
The aim of this work is to elucidate underlying etiologies, lesion locations, and outcomes of inferior rectus (IR) palsy of acquired origin. Retrospective search identified 44 patients with acquired IR palsy between April 2006 and May 2011 from four Neurology and two Ophthalmology Clinics in Korea. We analyzed clinical features, the results of radiological and laboratory evaluation, and prognosis. The most common causes were vascular (n = 16, 36 %) and trauma (n = 12, 27 %). Vascular disorders included microvascular ischemia (n = 10, 23 %), cerebral infarction (n = 5, 11 %), and dural arterio-venous fistula (n = 1, 2 %). Other causes were inflammation (n = 7, 16 %), myasthenia gravis (n = 5, 11 %), and thyroid ophthalmopathy (n = 1, 2 %). We were unable to determine the etiology in the remaining three patients (7 %). Most patients (95 %) showed a complete recovery with or without treatment. Acquired IR palsy mostly occurs with brainstem or orbital lesions, and has an excellent prognosis.
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Affiliation(s)
- Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
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40
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Tsuda H, Kageyama SI, Tanaka K, Miura Y, Kishida S. Bilateral Horizontal Gaze Paresis as an Initial Manifestation of Wernicke Encephalopathy. Neuroophthalmology 2012. [DOI: 10.3109/01658107.2012.686145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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41
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Mori M, Kuwabara S, Yuki N. Fisher syndrome: clinical features, immunopathogenesis and management. Expert Rev Neurother 2012; 12:39-51. [PMID: 22149656 DOI: 10.1586/ern.11.182] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since Miller Fisher's first report in 1956, evidence has accumulated about clinical and laboratory features, immunopathogenesis and treatment of Fisher syndrome (FS). Our literature review revealed the nature of FS. It has relatively uniform clinical and laboratory features. Ophthalmoplegia, ataxia and areflexia are essential prerequisites for an FS diagnosis, but there are several clinical variants with isolated ophthalmoplegia or ataxia. The discovery of serum anti-GQ1b antibody in FS has led to breakthroughs in FS research. The antibody is thought to be a key factor in the pathogenesis of FS, the understanding of which has progressed owing to the discovery of molecular mimicry between GQ1b and the lipo-oligosaccharides of Campylobacter jejuni and Haemophilus influenzae. The lesions responsible for the clinical symptoms have been debated but are close to clarification. Hence, the pathogenesis of FS has been made much clearer, although there are still some unanswered questions.
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Affiliation(s)
- Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
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43
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Ikuta N, Tada Y, Koga M. [Case of acute ophthalmoparesis with gaze nystagmus]. Rinsho Shinkeigaku 2012; 52:433-435. [PMID: 22790807 DOI: 10.5692/clinicalneurol.52.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 61-year-old man developed double vision subsequent to diarrheal illness. Mixed horizontal-vertical gaze palsy in both eyes, diminution of tendon reflexes, and gaze nystagmus were noted. His horizontal gaze palsy was accompanied by gaze nystagmus in the abducent direction, indicative of the disturbance in central nervous system. Neither limb weakness nor ataxia was noted. Serum anti-GQ1b antibody was detected. Brain magnetic resonance imaging (MRI) findings were normal. The patient was diagnosed as having acute ophthalmoparesis. The ophthalmoparesis and nystagmus gradually disappeared in 3 months. The accompanying nystagmus suggests that central nervous system disturbance may also be present with acute ophthalmoparesis.
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Affiliation(s)
- Naomi Ikuta
- Department of Neurology, Ube-Kousan Central Hospital
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44
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Abstract
BACKGROUND Antiganglioside antibodies are found in various neurological disorders that constitute a continuum from peripheral neuropathy to encephalitis. However, nystagmus has rarely been described in patients with ataxia associated with antiganglioside antibodies. METHODS From January 2008 to July 2009, we identified 3 patients with acute ataxia and nystagmus in 2 University Hospitals of Korea, who were found to have anti-GD1b, anti-GM1, or anti-GQ1b antibodies. RESULTS In addition to acute ataxia, all 3 patients showed various combinations of nystagmus, which included central positional nystagmus (n = 3), vertical nystagmus (n = 1), and periodic alternating nystagmus (n = 1). The spontaneous and positional nystagmus were mostly detectable only with the elimination of fixation and magnification of the eyes using video goggles. Two patients also exhibited gaze-evoked nystagmus that was noticeable without the aid of video goggles. Patients had serum IgG antibodies to GD1b, GM1, or GQ1b. Cerebrospinal fluid examination, nerve conduction studies, and brain MRI were normal. In all patients, the symptoms and signs resolved over 3-12 months. CONCLUSIONS Various forms of nystagmus with acute ataxia may be a sole or predominant manifestation of disorders related to antiganglioside antibodies. The nystagmus indicates a central pathology involving the cerebellum or brainstem in this antibody-associated disorder. Antiganglioside antibodies should be measured in patients with nystagmus and acute ataxia of undetermined etiology.
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45
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Arányi Z, Kovács T, Sipos I, Bereczki D. Miller Fisher syndrome: brief overview and update with a focus on electrophysiological findings. Eur J Neurol 2011; 19:15-20, e1-3. [DOI: 10.1111/j.1468-1331.2011.03445.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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46
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Rigamonti A, Lauria G, Longoni M, Stanzani L, Agostoni E. Acute isolated ophthalmoplegia with anti-GQ1b antibodies. Neurol Sci 2011; 32:681-2. [PMID: 21336874 DOI: 10.1007/s10072-011-0492-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 02/03/2011] [Indexed: 11/26/2022]
Abstract
Ophthalmoplegia without ataxia, areflexia or both has been designated as atypical Miller Fisher syndrome (MFS) or acute ophthalmoplegia (AO). This entity, first reported by Chiba et al. is associated with anti-GQ1b IgG antibodies.We report a patient with isolated acute ophthalmoplegia with high titer of anti-GQ1b IgG antibody activity in the acute phase in whom treatment with intravenous immunoglobulin (IVIg) led to the clinical recovery and the decrease in antibody titer.
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Affiliation(s)
- Andrea Rigamonti
- Department of Neurology, Alessandro Manzoni General Hospital, Lecco, Italy.
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47
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Yıldız ÖK, Balaban H, Özdemir S, Bolayır E, Topaktas S. Anti-GQ1b-Negative Miller Fisher Syndrome with Acute Areflexic Mydriasis and Cholinergic Supersensitivity. Neuroophthalmology 2011; 35:40-42. [PMID: 27956933 DOI: 10.3109/01658107.2010.539761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/03/2010] [Accepted: 09/06/2010] [Indexed: 11/13/2022] Open
Abstract
Miller Fisher syndrome is a rare variant of Guillain-Barré syndrome and it is characterised by ophthalmoplegia, ataxia, and areflexia. Pupillomotor involvement occurs in approximately half of the patients with the disorder. The authors report a patient with acute areflexic mydriasis, external ophthalmoplegia, areflexia, and ataxia. Although the pupils were unreactive to light and near stimuli, administration of 0.1% pilocarpine resulted in marked miosis, suggesting cholinergic supersensitivity. Antibodies against GM1, GD1b, and GQ1b were negative. This is the first report of acute areflexic mydriasis with cholinergic supersensitivity in anti-GQ1b-negative Miller Fisher syndrome.
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Affiliation(s)
- Özlem Kayım Yıldız
- Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Hatice Balaban
- Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Sibel Özdemir
- Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ertuğrul Bolayır
- Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Suat Topaktas
- Department of Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey
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48
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Liu GT, Volpe NJ, Galetta SL. Eye movement disorders. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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49
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Lee SH, Park SW, Kim BC, Kim MK, Cho KH, Kim JS. Isolated trochlear palsy due to midbrain stroke. Clin Neurol Neurosurg 2010; 112:68-71. [DOI: 10.1016/j.clineuro.2009.08.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 08/27/2009] [Accepted: 08/29/2009] [Indexed: 11/29/2022]
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50
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Jindal G, Parmar VR, Gupta VK. Isolated ptosis as acute ophthalmoplegia without ataxia, positive for anti-GQ1b immunoglobulin G. Pediatr Neurol 2009; 41:451-2. [PMID: 19931169 DOI: 10.1016/j.pediatrneurol.2009.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 04/13/2009] [Accepted: 07/14/2009] [Indexed: 11/19/2022]
Abstract
Anti-GQ1b IgG antibody syndrome comprises a wide range of diseases presenting with ophthalmoplegia and ataxia. Anti-GQ1b antibodies have been strongly associated in the literature with Miller Fisher Syndrome, with acute ophthalmoplegia associated with Guillain-Barré syndrome, and with isolated ophthalmoplegia. Acute ophthalmoplegia presents as various combinations of external and internal ophthalmoplegia. Reported here is a novel case of isolated ptosis as a manifestation of ophthalmoplegia. The present finding of bilateral ptosis and areflexia with anti-GQ1b IgG antibody positivity helps confirm the existence of the syndrome. Further research is needed on diagnosis and treatment.
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Affiliation(s)
- Geetanjali Jindal
- Department of Pediatrics, Government Medical College, Sector 32, Chandigarh, India.
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