Isolated cranial neuropathy associated with anti-glycolipid antibodies

Complete bilateral ophthalmoplegia with unilateral facial palsy in a child with anti-GQ1b syndrome

The classical phenotype of Miller Fisher syndrome is characterized by ophthalmoplegia, ataxia and areflexia. However, less extensive forms have been described. The authors report a 14-y-old boy with positive anti-GQ1b antibodies with unusual clinical findings. He presented with headache, double vision and vomiting for 7 d. Examination revealed complete opththalmoplegia, right lower-motor-neuron facial palsy, no limb weakness or cerebellar signs and normal fundus. CSF examination and MRI brain were normal. Electrophysiological studies showed normal limb nerve conduction studies, low CMAP amplitude of right facial nerve, abnormal blink reflex and negative repetitive-nerve-stimulation test. Anti-GQ1b antibodies were positive. The child was managed conservatively with gradual complete recovery. The patients with positive anti-GQ1b antibodies who do not demonstrate the full complement of the Miller Fisher syndrome triad have been reported previously. However, unilateral facial palsy has not been reported previously. This report further expands the phenotypic spectrum of anti-GQ1b syndrome.

Recurrent facial nerve palsy associated with anti-GQ1b IgG antibodies

Recurrent facial nerve palsy (RFNP) in childhood is usually considered to be a benign disorder. We report a 13-year-old female affected with RFNP in the absence of other neurologic signs, in which elevated serum IgG and IgM anti-GQ1b antibodies were detected. To our knowledge, this is the first example in the literature of RFNP, associated with anti-GQ1b IgG antibodies. The possible role of anti-GQ1b antibodies in isolated cranial neuropathy is discussed.