title: [Internal ophthalmoplegia in acute oropharyngeal palsy with anti-GQ1b and anti-GT1a IgG antibodies].
abstract: A patient with acute oropharyngeal palsy associated with internal ophthalmoplegia was reported. A 13-year-old boy had fever and diarrhea for two days. Ten days after resolution of these symptoms, he noticed difficulty in speaking (day 1). Neurological findings on day 4 included bilateral mydriasis, right abducens nerve palsy, nasal voice with absent pharyngeal reflex. Although superficial sensation was preserved, vibratory sensation was reduced in distal limbs. Tendon reflexes were generally absent. Neither ataxia nor dysautonomia was seen. Serum anti-glycolipid antibody assay on day 4 disclosed elevated IgG antibodies to GQ1b and GT1a. His cerebrospinal fluid on day 21 contained 6 mononuclear cells/microl with 137 mg/dl of total protein. Nerve conduction study on day 5 showed minimal sensory nerve involvement. Quantitative sudomotor axon reflex test was normal in the lower extremities. Low dose pilocarpine eyedrops dilated his pupils. Although mild cerebellar-like ataxia appeared on day 5, intravenous immunoglobulin (0.4 g/kg/day for four days) rapidly improved his neurological abnormalities. IgG anti-GQ1b antibody might contribute not only oropharyngeal weakness but also internal ophthalmoplegia in this patient.
authors: Department of Neurology, Kinki University of Medicine, Osaka, Japan.
authors: Kenji
authors: K
authors: Yamaji
authors: Masahiko
authors: M
authors: Atsumi
authors: Kazumasa
authors: K
authors: Saigoh
authors: Yoshimasa
authors: Y
authors: Kuzumoto
authors: Masami
authors: M
authors: Sada
authors: Minako
authors: M
authors: Hirakawa
authors: Daiji
authors: D
authors: Morita
authors: Yoshiyuki
authors: Y
authors: Mitsui
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001323:Autoantibodies / Q000097:blood*; D005732:Gangliosides / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology*; D008297:Male; D019846:Miller Fisher Syndrome / Q000175:diagnosis / Q000276:immunology*; D009886:Ophthalmoplegia / Q000150:complications*; D009960:Oropharynx / Q000276:immunology; D010243:Paralysis / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D005732:Gangliosides; D007074:Immunoglobulin G; C016481:trisialoganglioside GT1; C039129:GQ1b ganglioside