title: Total ocular akinesis: Miller Fisher or Guillain-Barré syndrome?
abstract: Total, bilateral ophthalmoplegia is very rare. More than 50% of cases are Miller Fisher (MFS) and Guillain-Barré (GBS) syndromes. There is a correlation of MFS with anti-GQ1b antibodies. High levels of GQ1b gangliosides are found in myelin sheathes of cranial nerves supplying the extraocular muscles. This may explain the association of anti-GQ1b antibodies with ophthalmoplegia. Anti-GQ1b were also found in cases of GBS accompanied by ophthalmoplegia, atypical MFS (MFS without ataxia), MFS/GBS overlap syndromes and Bickerstaff brainstem encephalitis. This has led some authors to classify them as 'anti-GQ1b syndromes'. In this article we describe a diagnostically difficult case of a patient with a very rare, total bilateral paralysis of all ocular muscles, accompanied by bilateral ptosis, diminished tendon reflexes of upper extremities, paresis and hypoesthesia of the left upper extremity.
authors.affiliation: Zakład Patofizjologii Widzenia Obuocznego i Leczenia Zeza I Katedry Chorób Oczu, Uniwersytet Medyczny w Łodzi, Łódź, Polska. kinja@o2.pl
authors.forename: Kinga
authors.initials: K
authors.lastname: Rajska
authors.forename: Jacek
authors.initials: J
authors.lastname: Rożniecki
authors.forename: Piotr
authors.initials: P
authors.lastname: Loba
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Zielińska
authors.forename: Anna
authors.initials: A
authors.lastname: Broniarczyk-Loba
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D020275:Guillain-Barre Syndrome / Q000175:diagnosis; D006801:Humans; D019846:Miller Fisher Syndrome / Q000175:diagnosis* / Q000628:therapy*; D035583:Rare Diseases; D012021:Reflex, Abnormal; D014785:Vision, Ocular