title: [Alert patients with mydriasis and fixed pupils].
abstract: Mydriasis is a rare phenomenon in non-comatose patients, usually caused by toxic agents or oculomotor neuropathy. We describe two patients who presented with mydriasis at the outpatient clinic. The first patient was a 46-year-old woman with mydriasis, headache, ptosis, ophthalmoplegia and transient ataxia after an influenza vaccination. The second was a 47-year-old woman with mydriasis, ophthalmoplegia, ptosis and ataxia after she had used doxycycline for an upper respiratory tract infection. In both patients, GQ1b-antibodies were detected and both were diagnosed with Miller Fisher syndrome. The second patient was treated with immunoglobulins, the other patient improved spontaneously. Miller Fisher syndrome is characterised by a triad of ophthalmoplegia, ataxia and areflexia. An infection or vaccination may give rise to an auto-immune response with GQ1b-antibodies directed against gangliosides in peripheral nerve tissue. The Miller Fisher syndrome has a good prognosis with spontaneous recovery ensuing in most patients. Treatment with immunoglobulins is required in some patients.
authors.affiliation: Atrium Medisch Centrum, afd. Neurologie, Heerlen.
authors.forename: Vera E W H
authors.initials: VE
authors.lastname: Meys
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koehler
mesh_terms: D001259:Ataxia / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D019846:Miller Fisher Syndrome / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D015878:Mydriasis / Q000175:diagnosis* / Q000209:etiology; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000209:etiology; D011681:Pupil Disorders / Q000175:diagnosis* / Q000209:etiology