Miastenia grave ocular: aspectos diagnósticos y evolución

Entrambasaguas, M. de; López-Bernabé, Roberto; López-Alemany, M

doi:10.33588/rn.4407.2006442

Cited by 4 publications

(1 citation statement)

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“…6 In this case, we did not find any clinical or laboratory evidence for MG. One of the neuromuscular junction disorders, such as botulism, can also cause generalized paralysis and ptosis. 7 In our patient, normal pupillary function with ascending paralysis led to the exclusion of botulism. The anti-GQ1b antibody has been found in GBS with ophthalmoplegia and MFS variants.…”

Section: Discussionmentioning

confidence: 51%

Rare Clinical Presentation in a Case of Pediatric Guillain-Barré Syndrome and Rehabilitation Outcome

Sharma

Gupta

Kenchaiah

et al. 2021

JNRP

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Nearly half of patients with Guillain-Barré syndrome (GBS) have cranial nerve involvement. Ocular muscle weakness or ophthalmoplegia occurs in ~10% of these patients. Patients presenting with bilateral ptosis, with or without ophthalmoplegia, is a rare finding. Anti-GQ1b antibody has been found in Miller Fisher syndrome and GBS with ophthalmoplegia variants. We report a case of GBS in a young boy presenting with rare presentation of tetraplegia, bilateral ptosis, and facial palsy, no ataxia but ophthalmoplegia with seronegative anti-GQ1b antibody. Patient showed recovery in cranial nerves involvement as well as with motor and functional recovery after 3 weeks of inpatient rehabilitation (Barthel Index score improved to 60/100 at the time of discharge from 20/100 at the time of admission). He was independent for most of the activity of daily livings including ambulation at the time of discharge from rehabilitation unit (p < 0.001).

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Section: Discussionmentioning

confidence: 51%

Rare Clinical Presentation in a Case of Pediatric Guillain-Barré Syndrome and Rehabilitation Outcome

Sharma

Gupta

Kenchaiah

et al. 2021

JNRP

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Ptosis as the Initial Presentation of Guillain-Barré Syndrome

Teng

Sung

2012

The Journal of Emergency Medicine

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Guillain-Barré syndrome with associated unilateral ptosis without ophthalmoplegia – a rare presentation: a case report and review of the literature

Ralapanawa

Kumarihamy²,

Jayalath

et al. 2019

J Med Case Reports

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Background Guillain-Barré syndrome is an acute inflammatory polyradiculoneuropathy. Nearly half of patients with Guillain-Barré syndrome have cranial nerve involvement. However, isolated bilateral ptosis without ophthalmoplegia is a rare manifestation, and isolated unilateral ptosis without ophthalmoplegia in Guillain-Barré syndrome has not previously been reported in the literature. Furthermore, only few cases of Guillain-Barré syndrome with cranial nerve enhancement visualized by gadolinium-enhanced magnetic resonance imaging have previously been reported. We describe the first reported case of unilateral ptosis without ophthalmoplegia in Guillain-Barré syndrome and associated multiple cranial nerve enhancement seen by gadolinium-enhanced magnetic resonance imaging. Case presentation Our patient was a 55-year-old Sinhalese man who was admitted to a tertiary care hospital in Sri Lanka with acute-onset progressive weakness in the lower limbs followed by the upper limbs. He had bilateral symmetrical flaccid quadriparesis with absent reflexes and flexor plantar response. Left-sided isolated partial ptosis without associated ophthalmoplegia was noted with normal pupils. The patient’s neurological examination was otherwise normal. A nerve conduction study showed a severe demyelinating type of polyneuropathy. No decremental response to repetitive nerve stimulation was observed, and the result of a single-muscle-fiber electromyogram was negative. A diagnosis of Guillain-Barré syndrome was made, and the patient was treated with intravenous immunoglobulin. His condition gradually deteriorated over the next few days, and he became quadriplegic despite the completion of immunoglobulin therapy. Later he developed multiple cranial nerve palsies, including bi-lateral lower motor neuron type facial nerve palsy, and he required mechanical ventilation. By this time, he had complete left-sided ptosis with a normal right eye. He never developed ophthalmoplegia or ataxia. Magnetic resonance imaging of the brain showed contrast enhancement in the intracranial part of multiple cranial nerve roots and basal leptomeninges. He gradually improved with plasmaparesis, and ptosis was the first to improve. Conclusions Even though Guillain-Barré syndrome was recognized a century ago, there are still many unanswered questions about it and its florid presentation. Large-scale studies are needed for better understanding of its pathophysiology and prototypes and to find answers for still-unanswered questions. The clinician must have a high index of suspicion and be familiar with mimics and prototypes to diagnose Guillain-Barré syndrome accurately without delay.

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Miastenia grave ocular: aspectos diagnósticos y evolución

Cited by 4 publications

References 0 publications

Rare Clinical Presentation in a Case of Pediatric Guillain-Barré Syndrome and Rehabilitation Outcome

Rare Clinical Presentation in a Case of Pediatric Guillain-Barré Syndrome and Rehabilitation Outcome

Ptosis as the Initial Presentation of Guillain-Barré Syndrome

Guillain-Barré syndrome with associated unilateral ptosis without ophthalmoplegia – a rare presentation: a case report and review of the literature

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