Affiliation:
1. Fattouma Bourguiba University Hospital Department of Neurology
Abstract
Abstract
Background :
Miller Fischer Syndrome (MFS) is a variant of Guillain barre syndrome. It is characterized by the triad of ophtalmoparesis, ataxia and areflexia. We describe in this paper an atypical case of a patient with MFS with positivity of glutamic acid decarboxylase (GAD) antibodies.
Case presentation :
A 35-year-old male was admitted to our neurology department with binocular diplopia, headache, and gait ataxia for 3days. Physical examination was remarkable for ophtalmoplegia, cerebellar ataxia and areflexia. MRI brain was normal. Also, cerebrospinal fluid analysis and electromyography within the first week were normal. Exaustif serelogical workup revealed negative anti-GQ1b antibody, but significant increase of GAD- antibody. Evolution was marked by the appearance of a facial diplegia. Neurophysiological studies showed evidence of sensoriel neuropathy of upper and lower limbs. Cerebrospinal fluid (CSF) analysis showed elevated protein. A maximal increment was revealed at twenty Hz repetitive nerve stimulation. Clinical diagnosis of atypical MFS was made. The patient was received a course of Immunoglobulines with completly recovery.
Conclusion : Our finding suggest that GAD-antibodies (GAD-Ab) may play a role in presynaptic neuromuscular transmission defect. It is responsible on an atypical painting by miller fischer mimicking an Lambert Eaton syndrome.
Publisher
Research Square Platform LLC
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