g(m1)-ganglioside and Diplopia

We herein present the case of a 38-year-old woman with left-sided oculomotor paralysis with ocular pain that developed after a respiratory infection. Her serum was positive for IgM against GM2 and GalNAc-GD1a gangliosides and cytomegalovirus. Thin-slice magnetic resonance imaging revealed enhanced abnormal tissue located primarily in the superolateral part of the left-sided cavernous sinus, which corticosteroids subsequently obscured with immediate resolution of the patient's ocular symptoms. These clinical features were consistent with those of Tolosa-Hunt syndrome (THS). Our findings in the present patient suggest that cytomegalovirus may provoke granuloma formation in the cavernous sinus, as reported in other various organs, thereby leading to the development of THS.

Topics: Adult; Antibodies, Viral; Autoantibodies; Cavernous Sinus; Cytomegalovirus; Cytomegalovirus Infections; Diplopia; Female; G(M1) Ganglioside; G(M2) Ganglioside; Granuloma; Humans; Imaging, Three-Dimensional; Immunocompetence; Immunoglobulin M; Macrophages; Magnetic Resonance Imaging; Prednisolone; Respiratory Tract Infections; Tolosa-Hunt Syndrome

Miller Fisher syndrome is a clinical variant of Guillain-Barré syndrome, characterized by acute-onset ophthalmoplegia, ataxia, and areflexia. It results from an immune response to a cross-reactive antigen between GQ1b ganglioside in human neurons and lipo-oligosaccharides of certain bacteria, e.g., Campylobacter jejuni. Anti-GQ1b antibody is a powerful diagnostic marker for Miller Fisher syndrome. However, only a small number of anti-GQ1b-negative Miller Fisher syndrome cases are documented. A 13-year-old boy demonstrated typical clinical features of Miller Fisher syndrome 1 week after C. jejuni enteritis, but was anti-GQ1b and anti-GM1b antibody-negative.

Topics: Ataxia; Blepharoptosis; Campylobacter Infections; Campylobacter jejuni; Child; Diplopia; G(M1) Ganglioside; Gangliosides; Humans; Male; Miller Fisher Syndrome; Neurologic Examination; Reflex