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Miller fisher syndrome: a pediatric case report
First Author: I. Hasnaoui MOROCCO
Co Author(s): E. Abdellah S. Hassina C. Bardi A. Berraho
Miller Fisher syndrome is defined by the triad of ophthalmoplegia, ataxia, and areflexia. Sensory disturbances, bulbar palsy and limb weaknesses can also be present. It is a rare variant of the parainfectious ascending polyneuropathy of Guillain-Barre syndrome, It differs in its clinical presentation and by anti-GQ1b antibody positivity . the ophthalmologic functional complaint is usually in the foreground guiding the diagnosis . Through this example, the range of ophthalmologic clinical manifestations are discussed.
ophthalmology B Department of Ibn Sina university hospital (speciality hospital ), Rabat, Morocco
A 12-year-old child was referred to our Hospital for acute onset of diplopia , left palpebral ptosis, and sixth left nerve palsy . The parents noticed that his pupils were larger than usual.2 weeks earlier he had had an upper respiratory tract infection. The day after, the patient worsened with drowsiness, external and internal ophthalmoplegia with absence of vertical gaze and convergence and bilateral ptosis, the pupils were dilated with sluggish reaction to light ,unsteady gait . Neurological evaluation showed generalized hypotonia and weakness with left predominance,Tendon reflexes were absent .
Biological examinations , Cerebral magnetic resonance imaging and electroencephalogramdid did not show any abnormalities, with the exception of serum anti-GQ1b IgG titre that was high . A diagnosis of anti-GQ1b syndrome MFS was made . he benefit from intravenous immune globulin therapy allowing resolution of ocular and neurological symptoms.The improvement in ophthalmoplegia was more gradual and resolved after 4 month.
In conclusion, we present an unusual case of complete ophthalmoplegia of the Fisher syndrome in a child, who made a complete recovery after immune globulin therapy. Although Fisher syndrome is rare in childhood,it's one of the causes of diffuse childhood ophthalmoplegia and it should be considered as a possible diagnosis in any child presenting with neurologic deficits that include the triad of ophthalmoplegia, ataxia and areflexia.
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