Unilateral oculomotor nerve palsy associated with anti-GQ1b IgG antibody

Abstract

We describe a patient with acute unilateral oculomotor nerve palsy that occurred after an upper respiratory infection. His serum showed a high titer of anti-GQ1b IgG antibody during the acute phase of the illness, suggesting a possible postinfectious immune-mediated mechanism. A previously healthy, 47-year-old man developed diplopia (day 1) 2 weeks after experiencing a fever and cough. On admission (day 12), his blood pressure was 110/70 mm Hg, his pulse rate was 78 beats per minute, and his body temperature was 36.5 °C. Neurologic examination revealed blepharoptosis and limitation of adduction and vertical gaze on the left side (figure). Convergence was impossible. Although both pupils were symmetric (4 mm) and promptly reactive to light, pupillometry revealed a delayed reaction to light in the left pupil (data not shown). These findings were compatible with left oculomotor nerve palsy. The other cranial nerves were intact. His gait was normal, and no muscle weakness, ataxia, or sensory …