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Sara Rodrigo-Rey1, Consuelo Gutiérrez-Ortiz2, Silvia Muñoz3

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Miller Fisher syndrome, a rare neurological disorder, can cause acute ophthalmoparesis in children. Early diagnosis and treatment with intravenous immunoglobulins lead to full recovery.

Keywords:
Miller Fisher syndromeacute ophthalmoparesisanti-GQ1b antibody syndromesantiganglioside antibodiesbilateral sixth nerve palsychildhood diplopia

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Area of Science:

  • Neurology
  • Ophthalmology
  • Immunology

Background:

  • Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome, characterized by ophthalmoplegia, ataxia, and areflexia.
  • Pediatric MFS is exceptionally uncommon, presenting diagnostic challenges in differentiating from other causes of acute ophthalmoparesis.

Observation:

  • A 13-year-old boy presented with acute horizontal binocular diplopia and headache following a gastrointestinal infection.
  • Ophthalmological examination showed bilateral ophthalmoparesis and diffuse hyporeflexia.
  • Brain MRI was normal, but lumbar puncture revealed albumin-cytological dissociation.

Findings:

  • Absence of anti-GQ1b antibodies, but presence of serum anti-GM1 antibodies was noted.
  • The patient received intravenous immunoglobulins (IVIg).
  • Complete recovery was observed within two weeks of treatment.

Implications:

  • This case highlights the importance of considering atypical MFS variants in pediatric patients with acute bilateral ophthalmoparesis.
  • The presence of anti-GM1 antibodies may indicate a specific subtype of MFS.
  • Prompt diagnosis and immunotherapy are crucial for favorable outcomes in pediatric MFS.