Recurrent Diplopia in a Pediatric Patient with Bickerstaff Brainstem Encephalitis
Introduction. Acute complete external ophthalmoplegia is a rare finding in clinical practice that is associated with diseases affecting the neuromuscular junction, the oculomotor nerves, or the brainstem. Ophthalmoplegia has been reported with acute ataxia in Miller Fisher syndrome (MFS) and Bickers...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-01-01
|
| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2016/5240274 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832555960364695552 |
|---|---|
| author | Scott A. McLeod Wallace Wee Francois D. Jacob Isabelle Chapados Francois V. Bolduc |
| author_facet | Scott A. McLeod Wallace Wee Francois D. Jacob Isabelle Chapados Francois V. Bolduc |
| author_sort | Scott A. McLeod |
| collection | DOAJ |
| description | Introduction. Acute complete external ophthalmoplegia is a rare finding in clinical practice that is associated with diseases affecting the neuromuscular junction, the oculomotor nerves, or the brainstem. Ophthalmoplegia has been reported with acute ataxia in Miller Fisher syndrome (MFS) and Bickerstaff brainstem encephalitis (BBE). Up to 95% of these cases are associated with anti-GQ1b antibodies. Only a small number of cases of anti-GQ1b negative MFS have been documented in pediatric patients. This is the first case reporting a recurrence of ocular symptoms in an anti-GQ1b antibody negative patient with BBE. Case Presentation. An 8-year-old Caucasian boy presented with complete external ophthalmoplegia without ptosis, cerebellar ataxia, and a disturbance of consciousness. He had recently recovered from a confirmed Campylobacter jejuni infection. On subsequent laboratory testing he was anti-GQ1b antibody negative. He had a recurrence of diplopia at four-week follow-up. Conclusions. This patient’s recurrence of diplopia was treated with a five-week course of oral corticosteroids which did not worsen his condition, and this may be a therapeutic option for similar patients. We will discuss the symptoms and treatment of reported pediatric cases of anti-GQ1b antibody negative cases of MFS and the variation between cases representing a spectrum of illness. |
| format | Article |
| id | doaj-art-d84809dac0a94fcb926f7e226bbd7a04 |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-d84809dac0a94fcb926f7e226bbd7a042025-02-03T05:46:49ZengWileyCase Reports in Neurological Medicine2090-66682090-66762016-01-01201610.1155/2016/52402745240274Recurrent Diplopia in a Pediatric Patient with Bickerstaff Brainstem EncephalitisScott A. McLeod0Wallace Wee1Francois D. Jacob2Isabelle Chapados3Francois V. Bolduc4Section of Developmental Pediatrics, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, CanadaDepartment of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, CanadaDepartment of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, CanadaDepartment of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, CanadaDepartment of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, CanadaIntroduction. Acute complete external ophthalmoplegia is a rare finding in clinical practice that is associated with diseases affecting the neuromuscular junction, the oculomotor nerves, or the brainstem. Ophthalmoplegia has been reported with acute ataxia in Miller Fisher syndrome (MFS) and Bickerstaff brainstem encephalitis (BBE). Up to 95% of these cases are associated with anti-GQ1b antibodies. Only a small number of cases of anti-GQ1b negative MFS have been documented in pediatric patients. This is the first case reporting a recurrence of ocular symptoms in an anti-GQ1b antibody negative patient with BBE. Case Presentation. An 8-year-old Caucasian boy presented with complete external ophthalmoplegia without ptosis, cerebellar ataxia, and a disturbance of consciousness. He had recently recovered from a confirmed Campylobacter jejuni infection. On subsequent laboratory testing he was anti-GQ1b antibody negative. He had a recurrence of diplopia at four-week follow-up. Conclusions. This patient’s recurrence of diplopia was treated with a five-week course of oral corticosteroids which did not worsen his condition, and this may be a therapeutic option for similar patients. We will discuss the symptoms and treatment of reported pediatric cases of anti-GQ1b antibody negative cases of MFS and the variation between cases representing a spectrum of illness.http://dx.doi.org/10.1155/2016/5240274 |
| spellingShingle | Scott A. McLeod Wallace Wee Francois D. Jacob Isabelle Chapados Francois V. Bolduc Recurrent Diplopia in a Pediatric Patient with Bickerstaff Brainstem Encephalitis Case Reports in Neurological Medicine |
| title | Recurrent Diplopia in a Pediatric Patient with Bickerstaff Brainstem Encephalitis |
| title_full | Recurrent Diplopia in a Pediatric Patient with Bickerstaff Brainstem Encephalitis |
| title_fullStr | Recurrent Diplopia in a Pediatric Patient with Bickerstaff Brainstem Encephalitis |
| title_full_unstemmed | Recurrent Diplopia in a Pediatric Patient with Bickerstaff Brainstem Encephalitis |
| title_short | Recurrent Diplopia in a Pediatric Patient with Bickerstaff Brainstem Encephalitis |
| title_sort | recurrent diplopia in a pediatric patient with bickerstaff brainstem encephalitis |
| url | http://dx.doi.org/10.1155/2016/5240274 |
| work_keys_str_mv | AT scottamcleod recurrentdiplopiainapediatricpatientwithbickerstaffbrainstemencephalitis AT wallacewee recurrentdiplopiainapediatricpatientwithbickerstaffbrainstemencephalitis AT francoisdjacob recurrentdiplopiainapediatricpatientwithbickerstaffbrainstemencephalitis AT isabellechapados recurrentdiplopiainapediatricpatientwithbickerstaffbrainstemencephalitis AT francoisvbolduc recurrentdiplopiainapediatricpatientwithbickerstaffbrainstemencephalitis |