title: [Acute divergence paralysis in the Miller Fisher syndrome].
abstract: We experienced a 53-year-old man diagnosed as Miller Fisher syndrome (MFS) associated with anti-GQ1b and anti-GT1a antibodies. He presented acute divergence paralysis, bulbar palsy, ascending hyperesthesia, areflexia and diminished vibration sense. External ophthalmoplegia and convergence paralysis were not seen, but he noticed double vision when looking at an object from the distance of more than 70 cm away on a day 10 of hospitalization. Hess chart test revealed an esotropic pattern, so the diagnosis of divergence palsy was made. Brain MRI was normal. Neurological deficits were treated with plasma exchange, resulting in favorable outcome. Divergence paralysis could be one of the clinical manifestations for MFS and might be due to nuclear or supranuclear damge of vergence-related neurons.
authors.affiliation: Department of Neurology, Hematology & Rheumatology, Shimane University School of Medicine.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Oguro
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Abe
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Bokura
authors.forename: Shotai
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D000208:Acute Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D019846:Miller Fisher Syndrome / Q000150:complications*; D009886:Ophthalmoplegia / Q000209:etiology*