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Unusual association of diseases/symptoms
Atypical Miller Fisher syndrome associated with glutamate receptor antibodies
  1. Taku Hatano1,
  2. Yoshiaki Shimada1,
  3. Ayako Kono1,
  4. Shin-ichiro Kubo2,
  5. Kazumasa Yokoyama1,
  6. Asako Yoritaka1,
  7. Toshiki Nakahara1,
  8. Yukitoshi Takahashi3,
  9. Nobutaka Hattori1
  1. 1Department of Neurology, Juntendo University, School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
  2. 2Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto-ku, Tokyo, Japan
  3. 3National Epilepsy Center, Shizuoka MIND, Urushiyama, Shizuoka, Japan
  1. Correspondence to Taku Hatano, thatano{at}


The present study reports a young woman with acute ataxia, areflexia and ophthalmoplegia, accompanied by psychosis and involuntary movements (IVMs) from disease onset. Anti-GQ1b and anti-GT1a antibodies were detected allowing for a diagnosis of Miller Fisher syndrome (MFS). However, psychosis and IVMs are atypical MFS symptoms and often mimic symptoms of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. Interestingly, the autoantibodies against full-length glutamate receptor-ε2 (GluRε2) and glutamate NR2B- and NR2A-containing heteromers (NR1/NR2) of NMDAR were also detected in the patient serum and cerebrospinal fluid. It was concluded that psychosis and IVMs in this patient were associated with autoantibodies against various GluRs.

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  • Competing interests None.

  • Patient consent Obtained.

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