Wasim Tariq Malik, Nabeel Muzaffar Syed, Raja Farhat Shoaib, Arsalan Ahmad.
Ophthalmoplegia and Areflexia with Positive GQ1b Antibodies: A Limited Form of Miller Fisher Syndrome.
Ann Pak Inst Med Sci Jan ;13(1):64-6.

Miller Fisher syndrome is a variant of Guillain–Barré syndrome (GBS) which has a clinical triad of ophthalmoplegia, ataxia and areflexia. They are associated with anti GQ1b antibodies which are directed against the GQ1b epitope of cranial and peripheral nerves. This syndrome may present with ophthalmoplegia without ataxia and it may present only with ataxia. They are diagnosed by the presence of GQ1b antibodies in the serum. 95% of patients with Miller-Fisher syndrome possess anti-GQ1b antibodies. We have a patient with bilateral ptosis and ophthalmoplegia and initially, we considered some common condition like thyroid disease, myasthenia gravis, cavernous sinus thrombosis, inflammatory conditions of eyes like inflammatory orbital myositis (IOM) and Tolosa-Hunt syndromes (THS). However, her initial investigations like MRI brain, nerve conduction studies, repetitive nerve stimulation and thyroid disease were normal. She did not respond to standard treatment of THS or IOM. Later on her GQ1b antibodies were present in the serum and she was discharged with a diagnosis of MFS. On follow-up visit after 1 week, she was much improved.

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