A Case of Neuromyelitis Optica Masquerading as Miller Fisher Syndrome

Furutani, Yasuji; Hata, Masaharu; Miyamoto, Kazuaki; Moribata, Yusaku; Yoshimura, Nagahisa

doi:10.1159/000368183

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…One case study reported a patient with NMOSD who presented with bilateral INO and AQP4 antibodies, masquerading as MFS. However, GQ1b antibodies were negative [ 15 ]. Cases of internuclear ophthalmoplegia with AQP4 antibodies are present in the literature.…”

Section: Discussionmentioning

confidence: 99%

A Patient With Miller Fisher Syndrome With Positive GQ1b and Aquaporin-4 Antibodies: Will There Be an Aquaporin-4 Antibody Associated Disorder?

Aylia,

Johri,

Spencer

et al. 2023

Cureus

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There have been many advancements in the field of neuromyelitis optica and neuromyelitis optica spectrum disorder since the discovery of aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein antibodies. It is also recognized that the pathological features associated with myelin oligodendrocyte glycoprotein antibodies are beyond the domain of neuromyelitis optica spectrum disorder and there is a separate nomenclature, namely myelin oligodendrocyte glycoprotein antibody associated disease. Currently, there is no aquaporin-4 antibody associated disorder, even though aquaporin-4 antibodies are not as widely present in other disorders. Miller Fisher syndrome (MFS) is a variant of Guillain Barré syndrome, in which there are positive GQ1b antibodies with no evidence of myelitis or optic neuritis. MFS is not considered a component of neuromyelitis optica spectrum disorder. We report on a patient with MFS that was positive for GQ1b and aquaporin-4 antibodies but negative for myelin oligodendrocyte glycoprotein antibodies and is devoid of any features of neuromyelitis optica spectrum disorder. This finding may lead to investigations and reports of other pathologies that are associated with the aquaporin-4 antibody.

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Section: Discussionmentioning

confidence: 99%

A Patient With Miller Fisher Syndrome With Positive GQ1b and Aquaporin-4 Antibodies: Will There Be an Aquaporin-4 Antibody Associated Disorder?

Aylia,

Johri,

Spencer

et al. 2023

Cureus

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“…By definition, these cases represent clinically isolated syndromes but in the absence of recurrent lesions in 12–36 months of follow-up. The phenotype is described in MS, NMOSD, stroke, and tumor ( 1 , 4 , 5 , 8 , 9 , 13 , 14 ). However, patients with these diagnoses tend to develop relapses and characteristic MRI changes ( 4 , 15 ).…”

Section: Discussionmentioning

confidence: 99%

“…Horizontal gaze paralysis has been described as a consequence of infarction ( 3 ), inflammation/demyelination as part of multiple sclerosis (MS) or neuromyelitis optica spectrum disorders (NMOSD) ( 2 , 4 , 5 ), hemorrhage ( 6 ), and metastasis ( 7 ). Of the previously reported non-vascular/tumor related cases, five of six had bilateral horizontal gaze palsies and three had solitary lesions on magnetic resonance imaging (MRI), localized to the pontine tegmentum.…”

Section: Introductionmentioning

confidence: 99%

Isolated Horizontal Gaze Palsy: Observations and Explanations

2017

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We present three cases that we suggest require a novel diagnosis and a reconsideration of current understandings of pontine anatomy. In this case series, we highlight a series of patients with monophasic, fully recovering inflammatory lesions in the pontine tegmentum not due to any of the currently recognized causes of this syndrome. We highlight other similar cases in the literature and suggest there may be a particular epitope for an as-yet-undiscovered antibody underlying the tropism for this area. We highlight the potential harm of misdiagnosis with relapsing inflammatory or other serious diagnoses with significant adverse impact on the patient. In addition, we propose that this would support a reinterpretation of the currently accepted anatomy of the pontine gaze inputs to the median longitudinal fasciculus and paramedian pontine reticular formation.

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“…Recent immunopathological studies have pointed towards aquaporin-4 as the target antigen in NMO and has been described to have a major role in the pathogenesis of NMO. Moreover, there is also a possible association of NMO with acute viral infection that may activate the immune system and initiate autoimmunity [ 9 , 10 ]. NMO has been reported to occur in association with mumps, acute infectious mononucleosis, varicella zoster virus, pulmonary tuberculosis, and syphilis [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Neuromyelitis Optica in a Nepalese Man

Subedi

Joshi

Bhandari

et al. 2017

Case Reports in Neurological Medicine

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Background Neuromyelitis optica is a severely disabling inflammatory disorder of the central nervous system of autoimmune etiology that mainly affects the optic nerves and spinal cord. Here, we present a case report detailing a patient with tingling and weakness of right upper and lower limbs who was neuromyelitis optica immunoglobulin G-positive. Case Presentation A 46-year-old Nepalese man presented to the hospital with a history of tingling and weakness of right upper and lower limbs that developed over a period of two months. Clinical evaluation showed diminished power across all major muscle groups in the right upper and lower limbs. Magnetic resonance imaging of his cervical spine showed T1 iso- to hypointense signal and T2 hyperintense signal in central cervical spinal cord from first to sixth cervical level, probably suggestive of myelitis or demyelination. The patient was immediately started on intravenous methylprednisolone. The diagnosis of neuromyelitis optica was later confirmed with strongly positive neuromyelitis optica immunoglobulin G. Conclusion In resource limited setting, in the absence of tests for neuromyelitis optica immunoglobulin G, treatment was started and the patient's condition started to get better. Hence, early initiation of aggressive immunosuppressive treatment is essential in such cases.

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A Case of Neuromyelitis Optica Masquerading as Miller Fisher Syndrome

Cited by 4 publications

References 15 publications

A Patient With Miller Fisher Syndrome With Positive GQ1b and Aquaporin-4 Antibodies: Will There Be an Aquaporin-4 Antibody Associated Disorder?

A Patient With Miller Fisher Syndrome With Positive GQ1b and Aquaporin-4 Antibodies: Will There Be an Aquaporin-4 Antibody Associated Disorder?

Isolated Horizontal Gaze Palsy: Observations and Explanations

Neuromyelitis Optica in a Nepalese Man

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