title: Bilateral internal ophthalmoplegia as an initial sole manifestation of Miller Fisher syndrome.
abstract: Although there have been reports regarding the frequent involvement of the pupils in Miller Fisher syndrome (MFS) and related syndromes, internal ophthalmoplegia has not been described as the initial sole manifestation of typical MFS. Recently, we encountered a woman with MFS whose initial manifestation was blurred vision because of bilateral tonic pupils. Investigations, including brain imaging, cerebrospinal fluid examination and nerve conduction studies were normal except for elevated serum levels of immunoglobulin G anti-GQ1b antibody. During the disease, she subsequently developed bilateral sixth and seventh nerve palsies, gait ataxia, and areflexia. We treated her with intravenous immunoglobulin and she showed a stepwise recovery from her illness. This case suggests that bilateral internal ophthalmoplegia can be a preceding sole manifestation of typical MFS.
authors.affiliation: Department of Neurology, Inje University, College of Medicine, 633-165 Gaegeum-dong, Busanjin-gu, Busan 614-735, Korea. neurobae@yahoo.co.kr
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Bae
authors.forename: Jong Kuk
authors.initials: JK
authors.lastname: Kim
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Oeung Kyu
authors.initials: OK
authors.lastname: Kim