Rinsho Shinkeigaku (Clinical Neurology)

Case Report

An overlap case of Fisher syndrome and pharyngeal-cervical-brachial variant of Guillain-Barré syndrome

Koji Shinoda, M.D.1)2), Hiroyuki Murai, M.D.1), Ken-ichi Shibata, M.D.1), Shoko Samejima, M.D.1), Shuji Kaneto, M.D.1), Nobuyoshi Takashima, M.D.1) and Kimihiro Tanaka, M.D.1)

1)Department of Neurology, Iizuka Hospital
2)Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University

A 29-year-old female developed diplopia, nasal voice and gait disturbance after an upper respiratory infection. On admission, she presented with bilateral external ophthalmoplegia, slight bilateral facial nerve palsy, dysarthria, dysphagia, cervical and brachial muscle weakness, ataxia and areflexia. She had serum anti-GT1a, anti-GQ1b and anti-galactocerebroside IgG antibodies. She was diagnosed with an overlap case of Fisher syndrome and pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. Intravenous immunoglobulin therapy was effective for the ophthalmoplegia and ataxia, but did not improve the bilateral facial nerve palsy and brachial muscle weakness. The facial nerve palsy clearly worsened despite improvement in other symptoms, and therefore highdose intravenous methylprednisolone therapy was added. The distinct response to treatment may be caused by different activity, production, clearance and reactivity to intravenous immunoglobulin of the autoantibodies. The present case suggests that treatment response and patterns of recovery differ according to the causative antiganglioside antibodies.
Full Text of this Article in Japanese PDF (356K)

(CLINICA NEUROL, 52: 30|33, 2012)
key words: pharyngeal-cervical-brachial variant of Guillain-Barré syndrome, Fisher syndrome, anti-GQ1b antibody, anti-GT1a antibody

(Received: 23-Jul-11)