Successive yet distinct episodes of isolated ophthalmoplegia associated with anti-GQ1b antibody

Abstract

Recurrent episodes of the Miller Fisher syndrome (MFS) are uncommon.1 Furthermore, isolated internal ophthalmoplegia is rare in MFS.2,3 We report a patient who presented first with internal/external ophthalmoplegia, then 7 years later with an isolated internal ophthalmoplegia associated with elevated anti-GQ1b IgG antibodies and confirmed Campylobacter jejuni enteritis. A 20-year-old Latino man first presented to an outside neurology group with double vision, photophobia, and ataxia following a bout of diarrhea 2 days prior to symptom onset. On examination there were limited extraocular movements, dilated, non-reactive pupils, impaired vibratory sense of the distal extremities, and normal reflexes. After unremarkable brain imaging and spinal fluid results, the patient was diagnosed with atypical MFS. No treatment was initiated and symptoms resolved over the course of 3 months. At age 27 years he presented again with the gradual onset of double vision, photophobia, and paresthesias of the …