Total ocular akinesis: Miller Fisher or Guillain-Barré syndrome?

Neurol Neurochir Pol. 2011 May-Jun;45(3):297-300. doi: 10.1016/s0028-3843(14)60083-9.


Total, bilateral ophthalmoplegia is very rare. More than 50% of cases are Miller Fisher (MFS) and Guillain-Barré (GBS) syndromes. There is a correlation of MFS with anti-GQ1b antibodies. High levels of GQ1b gangliosides are found in myelin sheathes of cranial nerves supplying the extraocular muscles. This may explain the association of anti-GQ1b antibodies with ophthalmoplegia. Anti-GQ1b were also found in cases of GBS accompanied by ophthalmoplegia, atypical MFS (MFS without ataxia), MFS/GBS overlap syndromes and Bickerstaff brainstem encephalitis. This has led some authors to classify them as 'anti-GQ1b syndromes'. In this article we describe a diagnostically difficult case of a patient with a very rare, total bilateral paralysis of all ocular muscles, accompanied by bilateral ptosis, diminished tendon reflexes of upper extremities, paresis and hypoesthesia of the left upper extremity.

Publication types

  • Review

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Female
  • Guillain-Barre Syndrome / diagnosis
  • Humans
  • Miller Fisher Syndrome / diagnosis*
  • Miller Fisher Syndrome / therapy*
  • Rare Diseases
  • Reflex, Abnormal*
  • Vision, Ocular