Research in Vestibular Science

Case Reports

Miller Fisher syndrome initially presented as bilateral internuclear ophthalmoplegia: a case report: Sanghyun Kim, Jusuck Lee, Daewoong Bae; Res Vestib Sci. 2025;24(1):46-49. Published online March 14, 2025; DOI: https://doi.org/10.21790/rvs.2024.028

Abstract PDF: Miller Fisher syndrome can present with various forms of ophthalmoplegia. This case report describes a 57-year-old woman who initially showed bilateral internuclear ophthalmoplegia (INO), with normal imaging and laboratory findings. Her neurologic symptoms progressed to include hyporeflexia and ataxia, leading to a diagnosis of Miller Fisher syndrome. Intravenous immunoglobulin treatment resulted in gradual improvement. This case report highlights the need to consider rare conditions like Miller Fisher syndrome in patients with INO-like features and unclear etiology.

Anti-GQ1b Antibody Syndrome Presenting with Severe Headache: Seo-Young Choi, Kyeung-Hae Kim, Jong Kuk Kim, Nam Jun Kim, Young Hee Kim, Kwang-Dong Choi; Res Vestib Sci. 2020;19(4):141-143. Published online December 15, 2020; DOI: https://doi.org/10.21790/rvs.2020.19.4.141

Abstract PDF: Anti-GQ1b antibody syndrome, including Miller Fisher syndrome, Guillain-Barré syndrome with ophthalmoplegia, Bickerstaff’s brainstem encephalitis, and acute ophthalmoplegia without ataxia, has overlapped clinical symptoms and mostly associated with anti-GQ1b immunoglobulin (Ig) G antibody. We report two cases of anti-GQ1b antibody syndrome mainly presenting with a severe headache. The 60-year-old man was admitted for severe headache and gait disturbance. Neurological examination revealed limb and truncal ataxia, areflexia, nystagmus, and ophthalmoplegia. Serum IgG anti-GQ1b antibody was positive. He recovered after intravenous (IV) immunoglobulin and steroid. The 23-year-old man suffered from severe headache (visual analogue scale=10) within the periorbital area. Ophthalmoplegia with gaze-evoked nystagmus were revealed. Serum IgG anti-GQ1b and anti-GT1a antibodies were positive. Headache was improved by IV immunoglobulin and steroid. The pathophysiology of headache in anti-GQ1b antibody syndrome is largely unknown. The affected nerve or structures in the brainstem including the trigeminovascular system may induce intractable severe headache.

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