A 64-year-old male presented with an emergency complaint of double vision ophthalmology and dizziness, apparently without other remarkable symptoms; however, an unstable standing was observed, which was not justified only by diplopia.
As the only antecedent of interest, the patient reported having been vaccinated against influenza for five days.
Visual acuity was 0.7 in both eyes (AO), and both pupils had refractive errors, with no previous contact with mydriasis.
The patient had a limitation in left atrial fibrillation, greater in left eye (LE), in the supraduction of BE, and difficulty for the rest of eye movements, referring horizontal diplopia.
The rest of the exploration was normal.
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The suspected diagnosis of a Fisher's syndrome is referred to the Neurology service, which detects ataxic gait, hyporeflexia, and discards weakness of the limbs and complete study admission for examination.
The results of blood tests and computed tomography (CT) performed in the emergency department were normal.
Twenty-four hours after admission there was a respiratory distress requiring oxygen and physical therapy, and in the following weeks new neurological symptoms were developed: facial paralysis, dysphonia and dysphagia.
During admission, a lumbar puncture was performed, which revealed a terminal albinocytological malformation, and a magnetic resonance imaging (MRI) that ruled out a space occupying lesion.
The electromyographic study did not provide additional information.
The immunological study was positive for GQ-1b antibody, confirming the initial diagnosis.
The patient improved his symptoms two weeks after admission, having received two cycles of immunoglobulins.
The clinical course was slow and polysymptomatic, persisting diplopia with limitation of bilateral manifestation in a prolonged way.
