好色先生

好色先生

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Abstract Details

A Tale of Two Eyes
Peripheral Nerve
P02 - (-)
187
BACKGROUND: A 35 year old male with no significant past medical history presented with a week of binocular horizontal diplopia. He reported an upper respiratory tract infection and diarrhea a few weeks prior to presentation. The neurologic exam was unremarkable except for the presence of bilateral sixth nerve palsy. MRI scan of brain and orbits was normal. Lumbar puncture revealed a normal opening pressure, cell counts, and a high normal CSF protein at 43 (Normal - 15-45 mg/dL). Lyme, HIV, RPR, TSH, ESR, HbA1C were all found to be negative. Camypylobacter jejuni antibody was equivocal and anti GQ1b antibody titer was 1:3200 (Normal 1:100). The patient had minimal improvement at a 3 week follow up. He was subsequently treated with IVIg with some notable recovery.
CONCLUSIONS: Isolated bilateral sixth nerve palsy has been described in the literature and its incidence is almost equal to unilateral sixth nerve palsy. The most common causes are tumors and demyelinating lesions. Miller fisher syndrome classically presents with a triad of ataxia, opthalmoplegia and areflexia . It may present only as acute ophthalmoperesis, however this has been described in very few case reports. Rarely is the presentation isolated bilateral sixth nerve palsy as seen in our patient. It is hypothesized that infection by microorganism expressing GQ1b epitope triggers production of IgG anti-GQ1b antibodies. These antibodies bind to GQ1b, which are highly expressed on occulomotor nerves and group 1a muscle spindles. This condition has a self-limited course and seldom causes complications. There is no well defined role of plasmapheresis or steroids for the treatment, but IVIg may reduce the duration of symptoms in certain cases.
Authors/Disclosures
Shilpi Mittal, MD (Thomas Jefferson University)
PRESENTER 		Dr. Mittal has nothing to disclose.
Matthew Imperioli, MD (Associated Neurologist) Dr. Imperioli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenix. Dr. Imperioli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ultragenyx Pharmaceuticals . Dr. Imperioli has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Law offices of Scott Doody.
Isaac E. Silverman, MD Dr. Silverman has received personal compensation in the range of $100,000-$499,999 for serving as an Expert Witness for Various Law Firms.
Mitchell S. Elkind, MD, MS, FAAN Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy.