Isolated internal ophthalmoplegia associated with IgG anti-GQ1b antibody

Acute ophthalmoparesis without ataxia and areflexia following infection or immunization may be related to Miller Fisher syndrome(MFS).1 Sera taken from patients with MFS, Bickerstaffs brainstem encephalitis (BBE), or Guillain-Barre syndrome (GBS) with ophthalmoparesis frequently have immunoglobulin (IgG) antibodies to GQ1b gangliosides during the acute phase of the disease.2-4 We report a patient with atypical MFS in which an isolated internal ophthalmoplegia was associated with anti-GQ1b antibodies. Patient report. A 33-year-old man presented 2 months before admission with an unstable gait, which had a fluctuating course. As a result of this, he had fallen once. Two weeks before admission (day 1), after having fever for 3 days, he subsequently experienced a decrease in visual acuity in both eyes and photophobia. On day 7 he complained of paresthesia in all fingers and on day 9 he developed diplopia. At admission on day 14 he was afebrile and fully conscious. Distance visual acuity was normal (20/15 OU), but near visual acuity was decreased to 20/30 OU due to decreased …