{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:11:01Z","timestamp":1772169061438,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.74299.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T00:00:00Z","timestamp":1649116800000}}],"reference-count":24,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T00:00:00Z","timestamp":1649116800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Neurological complications following vaccinations are extremely rare, but cannot be eliminated. Here, we report the first case of unilateral oculomotor nerve palsy (ONP) with anti-GQ1b antibody after receiving the Pfizer-BioNTech COVID-19 (BNT162b2) mRNA vaccine.<\/ns3:p>\n                  <ns3:p>A 65-year-old man developed diplopia and ptosis in the right eye 17 days after vaccination, without preceding infection. Neurological examination revealed mild blepharoptosis, limitation of adduction, and vertical gaze on the right side. Increased levels of anti-GQ1b ganglioside antibody in the serum and albuminocytologic dissociation in the cerebrospinal fluid were detected. Cranial magnetic resonance imaging showed swelling and enhancement of the right oculomotor nerve. The patient was diagnosed with right ONP accompanied with anti-GQ1b antibody, and intravenous immunoglobulin (IVIG) therapy for 5 days was administered. The limitation of adduction and vertical gaze improved, and ptosis markedly resolved after IVIG treatment. Given the temporal sequence of disease progression, laboratory findings, and a favorable response to IVIG, a causal relationship cannot be ruled out between the occurrence of ONP and COVID-19 immunization. Since immunomodulatory treatments significantly hasten the recovery and minimize the residual symptoms in anti-GQ1b antibody syndrome, clinicians should be aware of this clinical condition following COVID-19 vaccination.<\/ns3:p>","DOI":"10.12688\/f1000research.74299.2","type":"journal-article","created":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T10:40:07Z","timestamp":1649155207000},"page":"1142","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Case Report: Isolated, unilateral oculomotor palsy with anti-GQ1b antibody following COVID-19 vaccination"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3632-9679","authenticated-orcid":false,"given":"Takafumi","family":"Kubota","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5040-8985","authenticated-orcid":false,"given":"Takafumi","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kensuke","family":"Ikeda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Aoki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2022,4,5]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"229-239","DOI":"10.1080\/08990220.2018.1547697","article-title":"The aetiologies of the unilateral oculomotor nerve palsy: a review of the literature.","volume":"35","author":"H Raza","year":"2018","journal-title":"Somatosens Mot Res."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"677-679","DOI":"10.1002\/ana.410310619","article-title":"Serum IgG antibody to ganglioside GQ1b is a possible marker of Miller Fisher syndrome.","volume":"31","author":"A Chiba","year":"1992","journal-title":"Ann Neurol."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"57-65","DOI":"10.1056\/NEJM195607122550201","article-title":"An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia).","volume":"255","author":"M Fisher","year":"1956","journal-title":"N Engl J Med."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"204-206","DOI":"10.1136\/jnnp.56.2.204","article-title":"Miller Fisher syndrome is associated with serum antibodies to GQ1b ganglioside.","volume":"56","author":"H Willison","year":"1993","journal-title":"J Neurol Neurosurg 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Waheed","year":"2021","journal-title":"Cureus."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"102540","DOI":"10.1016\/j.amsu.2021.102540","article-title":"Post-COVID-19 vaccine Guillain-Barr\u00e9 syndrome; first reported case from Qatar.","volume":"67","author":"A Razok","year":"2021","journal-title":"Ann Med Surg (Lond)."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"577691","DOI":"10.1016\/j.jneuroim.2021.577691","article-title":"Sensory Guillain-Barre syndrome following the ChAdOx1 nCov-19 vaccine: Report of two cases and review of literature.","volume":"359","author":"Y Min","year":"2021","journal-title":"J Neuroimmunol."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"106887","DOI":"10.1016\/j.clineuro.2021.106887","article-title":"Guillain-Barr\u00e9 syndrome after AstraZeneca COVID-19-vaccination: A causal or casual association?","volume":"208","author":"A Introna","year":"2021","journal-title":"Clin Neurol 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Neurol."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/10-1142\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-1142\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-1142\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T05:50:15Z","timestamp":1649310615000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/10-1142\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,5]]},"references-count":24,"URL":"https:\/\/doi.org\/10.12688\/f1000research.74299.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.123036.r129880","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.123036.r129879","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.123036.r129880","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,5]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/10-1142\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.78037.r99811, Chieko Suzuki, Department of Neurology, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan, 30 Nov 2021, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/10-1142\/v1#referee-response-99811","order":0,"name":"referee-response-99811","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Takafumi Hasegawa<\/b>; \n<i>Posted: 30 Mar 2022<\/i>; Comment #1: If the condition is related to GQ1b, recovery phase may begin. Were there any signs of recovery before starting treatment?  \n<b>Reply: <\/b>Thank you very much for your comment. There were no obvious signs of recovery before IVIG treatment. He had gradually improved after the therapy.&nbsp;To further clarify the process of recovery, we added the last follow-up when he completely recovered on day 77 in the second paragraph of the diagnostic assessment section as follows:&nbsp;\u201cHe completely recovered on day 71 (\n<b>Figure 1 C<\/b>).\u201d  Comment #2: Elevated CSF protein is often observed in diabetes mellitus. Do you have follow-up data of CSF? If this condition is associated with GQ1b, there may be changes in CSF protein.  \n<b>Reply: <\/b>Thank you very much for your comment. We are sorry but we did not perform follow-up CSF analysis. As you mentioned, albuminocytologic dissociation in CSF might have improved after the therapy.  Comment #3: Contrast-enhanced findings of the oculomotor nerve on MRI have been reported in diabetic oculomotor palsy and idiopathic oculomotor palsy (Zhao et al. 20211; Yang et al. 20202). This finding is not specific to MFS.  \n<b>Reply: <\/b>We humbly accept this reviewer\u2019s comment. We deleted the following sentence in the 1\n<sup>st<\/sup> paragraph of the discussion: \u201cIn agreement with our case, cranial MRI demonstrated abnormal swelling, T2 hyperintensity, and gadolinium enhancement of the affected oculomotor nerve in classic forms of MFS, providing a useful tool for early diagnosis.\u201d","URL":"https:\/\/f1000research.com\/articles\/10-1142\/v2#referee-comment-8030","order":1,"name":"referee-comment-8030","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.123036.r129880, Miguel Garc\u00eda-Grimshaw, Department of Neurology and Psychiatry, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n, Mexico City, Mexico, 07 Apr 2022, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/10-1142\/v2#referee-response-129880","order":2,"name":"referee-response-129880","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}