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Case Reports
. 2021 Nov 18;14(11):e244273.
doi: 10.1136/bcr-2021-244273.

Immune-mediated ophthalmoparesis with anti-GD1a antibodies

Norma McKean  1   2 , Charmaine Chircop  3   2
Affiliations
Case Reports

Immune-mediated ophthalmoparesis with anti-GD1a antibodies

Norma McKean et al. BMJ Case Rep. .

Abstract

A young woman presented to neurology with a 1 month history of progressive diplopia on lateral gaze and a 1 week history of headaches. On examination she was found to have complex ophthalmoparesis with binocular horizontal diplopia, failure of abduction bilaterally and limited upgaze with convergence-retraction nystagmus. The rest of the neurological examination was normal. She was admitted for investigations: blood, CT brain, MR brain and lumbar puncture results were normal. Anti-GD1a antibodies were strongly positive; anti-GM1, anti-GM2 and anti-GD1b were also positive. On follow-up 3 weeks later, the complex ophthalmoplegia persisted. It was decided to treat with intravenous immunoglobulins (IVIgs) with good response but recurrence at 2 weeks post infusion. She was treated with 4 weekly IVIg courses and remains responsive and controlled over 1 year since presentation but becomes symptomatic in the week running up to each dose; thus, disease modifying treatment is currently being considered.

Keywords: cranial nerves; neurology; neurology (drugs and medicines); neuroopthalmology.

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Conflict of interest statement

Competing interests: None declared.

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