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Manjunathan S, Gunasekaran PK, Laxmi V, Kumar A, Saini L. Cogan's Lid Twitch Sign in a Child with Congenital Myasthenia. Neuropediatrics 2024; 55:148. [PMID: 38228156 DOI: 10.1055/s-0043-1778649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Sujatha Manjunathan
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Veena Laxmi
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ashna Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Lokesh Saini
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Cheung J, Alryalat SA, Al Deyabat O, Lee AG. Ganglioside (GM1) Immunoglobulin G Antibody Chronic Bilateral Ophthalmoplegia. J Neuroophthalmol 2024:00041327-990000000-00571. [PMID: 38354054 DOI: 10.1097/wno.0000000000002111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Jesse Cheung
- Lewis Katz School of Medicine of Temple University (JC), Philadelphia, Pennsylvania; Department of Ophthalmology (SAA, OAD), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Department of Ophthalmology (SAA), The University of Jordan, Amman, Jordan; Department of Ophthalmology (AGL), Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; Departments of Ophthalmology (AGL), Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas MD Anderson Cancer Center, Houston, Texas; Texas A&M College of Medicine (AGL), Bryan, Texas; and Department of Ophthalmology (AGL), The University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Lee J, Vishwanath V, Gill N. Dysphagia, Dysarthria, and Diplopia in a 14-year-old Boy. Pediatr Rev 2023; 44:592-594. [PMID: 37777648 DOI: 10.1542/pir.2021-005366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- July Lee
- Division of Pediatric Emergency Medicine and Transport
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Vijay Vishwanath
- Division of Pediatric Neurology
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- Clinical Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Natasha Gill
- Division of Pediatric Emergency Medicine and Transport
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- Clinical Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Yvon C, Nee D, Chan D, Malhotra R. Ophthalmoplegia associated with anti-GQ1b antibodies: case report and review. Orbit 2023; 42:192-195. [PMID: 34493154 DOI: 10.1080/01676830.2021.1974495] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 60-year-old man with longstanding bilateral asymmetrical ptosis presented with a partial third nerve palsy. His diplopia improved following an ice pack test. He did not report any symptoms related to the coronavirus disease 2019 (COVID-19), and nasopharyngeal swab was negative. Initial head imaging and blood work-up were normal except for a high titer of anti-GQ1b antibodies. The patient was subsequently diagnosed with acute ophthalmoparesis without ataxia which is part of the anti-GQ1b antibody syndrome spectrum. He made a spontaneous recovery over the following months without the need for immunotherapy. Clinical features, pathophysiology and a review of the literature are discussed herein. It is important to consider anti-GQ1b antibody syndrome in patients with symptoms of diplopia, ptosis or suspected ocular myasthenia.
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Affiliation(s)
- Camille Yvon
- Corneoplastics Unit, Queen Victoria Hospital NHS Trust, East Grinstead, UK
| | - Dominic Nee
- Neurology Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Dennis Chan
- Neurology Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Raman Malhotra
- Corneoplastics Unit, Queen Victoria Hospital NHS Trust, East Grinstead, UK
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Boutros N, Trikamji B. A rare overlap between Miller Fisher syndrome and pure motor Guillain-Barre syndrome. Acta Neurol Belg 2022:10.1007/s13760-022-02111-y. [PMID: 36201115 DOI: 10.1007/s13760-022-02111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/21/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Nader Boutros
- Department of Neurology, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Bhavesh Trikamji
- Department of Neurology, University of California Riverside School of Medicine, Riverside, CA, USA.
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Glover K, Mishra D, Singh TRR. Epidemiology of Ocular Manifestations in Autoimmune Disease. Front Immunol 2021; 12:744396. [PMID: 34795665 PMCID: PMC8593335 DOI: 10.3389/fimmu.2021.744396] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 01/19/2023] Open
Abstract
The global prevalence of autoimmune diseases is increasing. As a result, ocular complications, ranging from minor symptoms to sight-threatening scenarios, associated with autoimmune diseases have also risen. These ocular manifestations can result from the disease itself or treatments used to combat the primary autoimmune disease. This review provides detailed insights into the epidemiological factors affecting the increasing prevalence of ocular complications associated with several autoimmune disorders.
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Affiliation(s)
| | | | - Thakur Raghu Raj Singh
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, Belfast, United Kingdom
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Ramirez-Sanchez C, Syed R, Meier A, LaBuzetta JN, Hylton DJ, Taremi M. A unique case of Miller Fisher-Guillain-Barré overlap syndrome in a liver transplant recipient. J Neurovirol 2021; 27:797-801. [PMID: 34550544 PMCID: PMC8456682 DOI: 10.1007/s13365-021-01015-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/02/2021] [Accepted: 08/24/2021] [Indexed: 11/24/2022]
Abstract
Guillain-Barré syndrome (GBS) is an ascending demyelinating polyneuropathy often associated with recent infection. Miller Fisher syndrome represents a variant with predominant facial and cranial nerve involvement, although Miller Fisher and Guillain-Barré overlap syndromes can occur. Guillain-Barré spectrum syndromes have been thought to be rare among solid organ transplant recipients. We describe an immunocompromised patient with a liver transplant who presented with ophthalmoplegia and bulbar deficits. His symptoms rapidly progressed to a state of descending paralysis involving the diaphragm; he then developed acute respiratory failure and eventually developed quadriparesis. Electromyography and a nerve conduction study demonstrated a severe sensorimotor axonal polyneuropathy consistent with Miller Fisher variant Guillain-Barré syndrome. Despite several negative nasopharyngeal swabs for COVID-19 polymerase chain reaction, a serology for SARS-CoV-2 IgG was positive. He was diagnosed with Miller Fisher-Guillain-Barré overlap syndrome with rapid recovery following treatment with plasma exchange. Although Guillain-Barré is a rare complication in solid organ transplant recipients, this case highlights the importance of rapid diagnosis and treatment of neurologic complications in transplant patients. Furthermore, it demonstrates a possible case of neurological complications from COVID-19 infection.
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Affiliation(s)
- Claudia Ramirez-Sanchez
- Department of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA, USA.
| | - Rehan Syed
- Department of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Angela Meier
- Department of Anesthesiology, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Jamie Nicole LaBuzetta
- Department of Neurosciences, Division of Neurocritical Care, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Diana J Hylton
- Department of Anesthesiology, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Mahnaz Taremi
- Department of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA, USA
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Barsoum Z. Pediatric Miller Fisher Syndrome and Ocular Myasthenia Gravis (A Reminder of Clinical Mimicry): A Case Report. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1732484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractMiller Fisher syndrome (MFS) is a rare immune-mediated neuropathy that often presents with diplopia and bilateral external ophthalmoplegia. Other neurological deficits may occur such as ataxia and areflexia but not in all cases. Although MFS is a clinical diagnosis, serological confirmation is possible by identifying the anti-GQ1b antibody found in the majority of patients. Myasthenia gravis is an autoimmune disorder of the availability of acetylcholine receptors in the neuromuscular junction. Ocular myasthenia gravis is a disease subtype characterized by variable patterns of weakness of extraocular muscles, eyelid elevator, and orbicular muscle in which the initial sign in most adults and children is ptosis. We report a child with MFS who presented with clinical signs suggestive of ocular myasthenia gravis, but in whom the correct diagnosis was made on the basis of serological testing for the anti-GQ1b antibody. We aim to highlight the similarity between the two rare conditions and address the importance of early liaison with neurologists and ophthalmologists in reaching to the proper diagnosis.
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Affiliation(s)
- Zakaria Barsoum
- Department of Paediatric, South West Acute Hospital, Enniskillen, Northern Ireland, United Kingdom
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Yonemoto K, Nomura S, Shimizu A, Sakajiri K, Nitta E. [A case of Miller Fisher syndrome with a false-positive edrophonium test]. Rinsho Shinkeigaku 2019; 59:345-348. [PMID: 31142707 DOI: 10.5692/clinicalneurol.cn-001236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 69-year-old woman presented with acute bilateral ptosis, ophthalmoplegia, ataxia, and hyporeflexia in the extremities following an antecedent upper respiratory infection. We suspected that she had Miller Fisher syndrome (MFS) and performed an edrophonium test (ET) to rule out myasthenia gravis (MG). Edrophonium chloride improved the patient's bilateral ptosis, but not her ophthalmoplegia. Given the absence of the waning phenomenon on electrophysiological examination, the anti-acetylcholine receptor antibody, and a diurnal variation of symptoms, we concluded that the ET result was a false-positive. A diagnosis of MFS was confirmed by the presence of a positive anti-GQ1b antibody. To our knowledge, this is the first case report of MFS with a false-positive ET.
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Affiliation(s)
- Kosuke Yonemoto
- Department of Neurology, National Hospital Organization Kanazawa Medical Center
| | - Shunichi Nomura
- Department of Neurology, National Hospital Organization Kanazawa Medical Center
| | - Ai Shimizu
- Department of Neurology, Kanazawa University School of Medicine
| | - Kenichi Sakajiri
- Department of Neurology, National Hospital Organization Kanazawa Medical Center
| | - Eishun Nitta
- Department of Neurology, National Hospital Organization Kanazawa Medical Center
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Abstract
Miller Fisher syndrome (MFS) was first recognized by James Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. Later, it was described in 1956 by Charles Miller Fisher as a possible variant of Guillain-Barré syndrome (GBS). Here, we write a case of a patient with atypical presentation of this clinical triad as the patient presented with double vision initially due to unilateral ocular involvement that progressed to bilateral ophthalmoplegia. He developed weakness of the lower extremities and areflexia subsequently. A diagnosis of MFS was made due to the clinical presentation and the presence of albuminocytologic dissociation in the cerebrospinal fluid (CSF) along with normal results of brain imaging and blood workup. The patient received intravenous immune globulin (IVIG), and his symptoms improved. The initial diagnosis of MFS is based on the clinical presentation and is confirmed by cerebral spinal fluid analysis and clinical neurophysiology studies. This case which emphasizes the knowledge of a rare syndrome can help narrow down the differentials to act promptly and appropriately manage such patients.
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Affiliation(s)
- Sumera Bukhari
- Internal Medicine, Seton Hall University-St. Francis Medical Center, Trenton, NJ
| | - Javier Taboada
- Neurology, Seton Hall University-St. Francis Medical Center, Trenton, NJ
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Yepishin IV, Allison RZ, Kaminskas DA, Zagorski NM, Liow KK. Miller Fisher Syndrome: A Case Report Highlighting Heterogeneity of Clinical Features and Focused Differential Diagnosis. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2016; 75:196-199. [PMID: 27437164 PMCID: PMC4950094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Miller Fisher Syndrome (MFS) is a rare variant of Guillain-Barré Syndrome (GBS) that has a geographically variable incidence. It is largely a clinical diagnosis based on the cardinal clinical features of ataxia, areflexia, and opthalmoplegia, however, other neurological signs and symptoms may also be present. Serological confirmation with the anti-GQ1b antibody is available and allows for greater diagnostic certainty in the face of confounding symptoms. A self-limiting course is typical of MFS. The following case report is that of a patient who presented with generalized weakness, somatic pain, inability to walk, and diplopia following an upper respiratory illness. The patient exhibited the classic triad of ataxia, areflexia, and opthalmoplegia characteristic of MFS, but also had less typical signs and symptoms making for a more challenging diagnostic workup. Our suspected diagnosis of MFS was serologically confirmed with positive anti-GQ1b antibody titer and the patient was successfully treated with Intravenous immune globulin (IVIG).
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Affiliation(s)
- Ilya V Yepishin
- Family Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (IVY)
| | - Randall Z Allison
- Family Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (IVY)
| | - David A Kaminskas
- Family Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (IVY)
| | - Natalia M Zagorski
- Family Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (IVY)
| | - Kore K Liow
- Family Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (IVY)
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