A Case of Anti-GQ1b-Positive Atypical Miller Fisher Syndrome With Pupil Involvement

Jae Hwan Ahn; Sul Gee Lee

doi:10.3341/jkos.2009.50.4.645

Journal List > J Korean Ophthalmol Soc > v.50(4) > 1008538

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Ahn and Lee: A Case of Anti-GQ1b-Positive Atypical Miller Fisher Syndrome With Pupil Involvement

Original Article

J Korean Ophthalmol Soc 2009;50(4):645-648.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.4.645

A Case of Anti-GQ1b-Positive Atypical Miller Fisher Syndrome With Pupil Involvement

Jae Hwan Ahn, MD, Sul Gee Lee, MD, PhD

Department of Opthalmology, Inje University, Pusan Paik Hospital, Busan, Korea

Address reprint requests to Sul Gee Lee, MD, PhD, Department of Ophthalmology, Inje University, Pusan Paik Hospital #633-165 Gaegum-dong, Busanjin-gu, Busan 614-735, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329, E-mail: judysg@hanmail.net

Received 2 June 2008 Accepted 24 November 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of atypical Miller Fisher syndrome with pupil involvement.

Case summary

An 18-year-old woman visited our clinic with a headache and blurred vision. Ophthalmic examination revealed a corrected visual acuity of 20/20 in both eyes, with both pupils dilated to 7.5 mm. There was a loss of light reflex and near reflex in both eyes. Ocular motor examination revealed bilateral abduction, and supraduction limitation, and mild adduction limitation. Neurological examination demonstrated hyporeflexia without ataxia. Brain CT, brain MRI, nerve conduction test, CSF study, and thyroid function tests were normal. The serologic anti-GQ1b IgG test was positive.

Conclusions

We confirmed a case of atypical Miller Fisher syndrome with an anti-GQ1 antibody test that had pupil involvement, areflexia, and acute ophthlamoparesis.

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Keywords: Anti GQ1b IgG antibody, Miller-Fisher syndrome, Pupil

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Figure 1.

On the 3rd day of hospitalization, both pupils were dilated and ocular motor examination revealed bilateral complete limitation of abduction and supraduction and mild limitation of adduction.

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Figure 2.

Eight weeks after the onset of symptoms, pupil diameters reduced to 4 mm, and oculomotor examination revealed only mild bilateral limitation of abduction.

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