Unsmiling

A 22 year old woman presents with the inability to smile or frown since waking up around 6 hours ago. She has difficulty in moving her eyes, complains of double vision, and finds it difficult to walk.

Close questioning reveals a mild diarrheal episode about 2 weeks ago, which resolved spontaneously. Her surgical and family histories are unremarkable.

She does not smoke, only drinks socially, and denies using recreational drugs. She is sexually active, with a single stable partner.

Select Relevant Investigations
Contrast MRI Brain

Performed

The gadolinium weighted MRI shows bilateral enhancement of the cranial nerves III, VI, and VII. No other abnormalities are present.
Lumbar Puncture

Performed

Appearance: clear and colorless
Cell count: 4 (0-5)
Total protein: 450 mg/100 mL (15-60)
Glucose: 65 mg/100 mL (50-80)
HIV serology: negative
EBV serology: negative
Anti-Borrelia burgdorferi antibodies: negative
Electrodiagnostic Studies

Performed

Nerve conduction studies and electromyography of the affected cranial nerves reveal no abnormalities.
Anti-GQ1b antibodies

Performed

Anti-GQ1b antibody levels are markedly elevated.

Select Relevant Management
Close Observation
IV Corticosteroids
IV Immunoglobulins
ICU Care