engleski

Diagnostic challenge of anti-GQ1b syndrome : differential diagnosis between Miller Fischer syndrome and Bickerstaff ’s brainstem encephalitis

Miller Fisher syndrome (MFS) may be considered as a rare variant of Guillain-Barré syn- drome (GBS). Together with GBS, Bickerstaff ’s brainstem encephalitis and acute ophthalmoparesis without ataxia, MFS is in the group of anti-GQ1b syndrome disorders (anti-GQ1b Sy). Among all GBS variants, MFS is distinctive, presenting with acute symptoms of ophthalmoparesis, ataxia and arefl exia, but without pro- gressive limb weakness as the most characteristic symptom of GBS. MFS is a clinical entity based on typical clinical presentation and defi ned symptoms, and the fi nding of specifi c anti-GQ1b antibodies is not suffi cient for MFS diagnosis. Th e objective of this case report is to demonstrate the diversity of anti-GQ1b Sy clinical presentation. Here we describe a case of a male patient with acute bilateral ophthalmoparesis, mydriasis and unilateral right infranuclear facial nerve palsy, in whom muscle tendon refl exes were preserved and no atax- ia was present. Serum antiganglioside antibody test was positive for anti-GQ1b antibody, confi rming the presupposed diagnosis of MFS. Although MFS is rare, it should be considered in patients with acute develop- ment of ophthalmoplegia. In rare cases of MFS with uncommon presentation, as it was in our case, positive serum antiganglioside antibody test will lead to the right diagnosis.

antiganglioside antibody ; anti-GQ1b syndrome ; Bickerstaff ’s encephalitis ; Guillain-Barré syndrome ; Miller Fisher syndrome

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