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Anti-GQ1b IgG antibody is often found in the sera of patients with Miller Fisher syndrome, Bickerstaff’s brain stem encephalitis, Guillain–Barré syndrome with ophthalmoplegia, acute ophthalmoparesis without ataxia, and occasionally, in isolated internal ophthalmoplegia and chronic ophthalmoplegia.1–3 These conditions may be designated as anti-GQ1b IgG antibody syndrome.1 We report a patient who showed three different phenotypes of the anti-GQ1b IgG antibody syndrome at different periods.
Case report
The patient was a 19 year old woman. At age 10, she visited a neurologist because of diplopia and an unsteady gait two weeks after a respiratory tract infection. Neurological examination showed ophthalmoplegia, dilated pupils with sluggish pupillary responses, areflexia, and cerebellar ataxia. Laboratory findings including nerve conduction studies were normal except for a slight increase in CSF protein (40 mg/dl) without pleocytosis. Within three months, her condition gradually improved and she was discharged without a neurological deficit except for persistent areflexia.
At age 17, she noticed mild diplopia, which gradually got worse. She visited our hospital with the complaint of slowly progressive diplopia. Although ocular movements were not restricted, her pupils were dilated bilaterally …