Acute Ophthalmoparesis in a Child with Anti-GQ1 b IgG Antibody

Abstract

Sir,In childhood, the majority of cases of acquired isolated nervus abducens paresis are caused by neoplasm (39%), trauma (20 %), and inflammation (17%) [6]. In contrast, acquired isolated benign VIth cranial nerve palsy is a rare condition (3 to 5%) in a pediatric setting [6,8]. In several case series of unilateral benign paresis the symptomatology was believed to be due to neuritis after viral infection. Bilateral benign abducens nerve palsy has been reported only in single cases [8].In adults, VIth nerve palsy can occur in Miller-Fisher syndrome (MFS), where it is characterized by acute onset of external ophthalmoplegia, cerebral ataxia, and very frequently a loss of tendon reflexes, which is regarded as a cranial nerve variant of Guillain-BarrØ syndrome (GBS). As in GBS and Bickerstaff brainstem encephalitis, MFS is believed to be of autoimmune pathogenesis. The fact that over 90% of MFS show anti-ganglioside IgG-antibodies for the GQ1 b epitope [5], which is present predominantly in the extramedullary part of IIIrd, IVth, and VIth nerves [2, 3], speaks for this.

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“…Moreover, there may be supportive findings such as CSF albumin-cytological dissociation, electrophysiological abnormalities, and serum anti-GQ1b autoantibodies 25 . Just few cases have been previously reported in adults 29 , even less in childhood 7 , 10 , 11 , 15 , 23 , 24 , 27 . There were serum anti-GQ1b antibodies in all the cases, and occasionally antibodies against ganglioside complex.…”