{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T15:21:20Z","timestamp":1778944880293,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2012,12,1]],"date-time":"2012-12-01T00:00:00Z","timestamp":1354320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2012,12,1]],"date-time":"2012-12-01T00:00:00Z","timestamp":1354320000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["R01\u2010EY06717"],"award-info":[{"award-number":["R01\u2010EY06717"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["OVS"],"published-print":{"date-parts":[[2012,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose.<\/jats:title>\n                    <jats:p>Miller Fisher syndrome (MFS) is a rare immune\u2010mediated neuropathy that commonly presents with diplopia after the acute onset of complete bilateral external ophthalmoplegia. Ophthalmoplegia is often accompanied by other neurological deficits such as ataxia and areflexia that characterize MFS. Although MFS is a clinical diagnosis, serological confirmation is possible by identifying the anti\u2010GQ1b antibody found in most of the affected patients. We report a patient with MFS who presented with clinical signs suggestive of ocular myasthenia gravis but in whom the correct diagnosis was made on the basis of serological testing for the anti\u2010GQ1b antibody.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report.<\/jats:title>\n                    <jats:p>An 81\u2010year\u2010old white man presented with an acute onset of diplopia after a mild gastrointestinal illness. Clinical examination revealed complete bilateral external ophthalmoplegia and left\u2010sided ptosis. He developed more marked bilateral ptosis, left greater than right, with prolonged attempted upgaze. He was also noted to have a Cogan lid twitch. Same day evaluation by a neuro\u2010ophthalmologist revealed mild left\u2010sided facial and bilateral orbicularis oculi weakness. He had no limb ataxia but exhibited a slightly wide\u2010based gait with difficulty walking heel\u2010to\u2010toe. A provisional diagnosis of ocular myasthenia gravis was made, and anticholinesterase inhibitor therapy was initiated. However, his symptoms did not improve, and serological testing was positive for the anti\u2010GQ1b immunoglobulin G antibody, supporting a diagnosis of MFS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions.<\/jats:title>\n                    <jats:p>Although the predominant ophthalmic feature of MFS is complete bilateral external ophthalmoplegia, it should be recognized that MFS has variable associations with lid and pupillary dysfunction. Such confounding neuro\u2010ophthalmic features require a thorough history, neurological examination, neuroimaging, and serological testing for the anti\u2010GQ1b antibody to arrive at a diagnosis of MFS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/opx.0b013e31827717c1","type":"journal-article","created":{"date-parts":[[2012,11,22]],"date-time":"2012-11-22T02:41:33Z","timestamp":1353552093000},"source":"Crossref","is-referenced-by-count":18,"title":["Miller Fisher Syndrome Mimicking Ocular Myasthenia Gravis"],"prefix":"10.1002","volume":"89","author":[{"given":"Scott A.","family":"Anthony","sequence":"first","affiliation":[{"name":"Optometry Clinic Louis Stokes Cleveland Veterans Affairs Medical Center Cleveland Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew J.","family":"Thurtell","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences University of Iowa Iowa City Iowa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. John","family":"Leigh","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospitals Case Medical Center Cleveland Ohio"},{"name":"Neurology Service and Daroff\u2010Dell'Osso Ocular Motility Laboratory Veterans Affairs Medical Center Cleveland Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,12,1]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0165-5728(99)00213-1","article-title":"The immunopathogenesis of Miller Fisher syndrome","volume":"100","author":"Willison HJ","year":"1999","journal-title":"J Neuroimmunol"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.2147\/NDT.S8219","article-title":"Role of anti\u2010GQ1B antibody in differential diagnosis of acute ophthalmoparesis","volume":"6","author":"Boylu EE","year":"2010","journal-title":"Neuropsychiatr Dis Treat"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1080\/08820530802049996","article-title":"Neuromuscular junction dysfunction in Miller Fisher syndrome","volume":"23","author":"Silverstein MP","year":"2008","journal-title":"Semin Ophthalmol"},{"key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/WNO.0b013e3182224b92","article-title":"Use of the Cogan lid twitch to identify myasthenia gravis","volume":"31","author":"Singman EL","year":"2011","journal-title":"J Neuroophthalmol"},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1001\/archneurol.2012.437","article-title":"Presence and pathogenic relevance of antibodies to clustered acetylcholine receptor in ocular and generalized myasthenia gravis","volume":"69","author":"Jacob S","year":"2012","journal-title":"Arch Neurol"},{"key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s11910-009-0055-0","article-title":"Neuro\u2010ophthalmology and the anti\u2010GQ1b antibody syndromes","volume":"9","author":"Saul RF","year":"2009","journal-title":"Curr Neurol Neurosci Rep"},{"key":"e_1_2_7_8_1","doi-asserted-by":"crossref","unstructured":"OverellJR HsiehST OdakaM YukiN WillisonHJ.Treatment for Fisher syndrome Bickerstaff's brainstem encephalitis and related disorders. Cochrane Database Syst Rev2007:CD004761.","DOI":"10.1002\/14651858.CD004761.pub2"},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/WNO.0b013e3181c2514b","article-title":"The Fisher variant of Guillain\u2010Barr\u00e9 syndrome (Fisher syndrome)","volume":"29","author":"Snyder LA","year":"2009","journal-title":"J Neuroophthalmol"},{"key":"e_1_2_7_10_1","first-page":"57","article-title":"The Miller Fisher syndrome. Review of the literature","volume":"12","author":"Berlit P","year":"1992","journal-title":"J Clin Neuroophthalmol"},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S1473-3099(01)00019-6","article-title":"Infectious origins of, and molecular mimicry in, Guillain\u2010Barr\u00e9 and Fisher syndromes","volume":"1","author":"Yuki N","year":"2001","journal-title":"Lancet Infect Dis"},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1097\/WCO.0b013e32833cc968","article-title":"Autoimmune mediated neuromuscular junction defects","volume":"23","author":"Farrugia ME","year":"2010","journal-title":"Curr Opin Neurol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1212\/01.WNL.0000160399.08456.7C","article-title":"Antecedent infections in Fisher syndrome: a common pathogenesis of molecular mimicry","volume":"64","author":"Koga 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