[Pubmed] Isolated Ophthalmoplegia: An Uncommon Presentation of Anti-glutamic Acid Decarboxylase 65 (Anti-GAD65) Neurolog

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Cureus. 2024 Dec 9;16(12):e75375. doi: 10.7759/cureus.75375. eCollection 2024 Dec.

ABSTRACT

Isolated ophthalmoplegia as an anti-glutamic acid decarboxylase 65 (anti-GAD65) antibody-associated neurological syndrome is rare. We present a case of a 22-year-old pregnant Hispanic female patient who presented initially with a left oculomotor nerve palsy following an emergency department (ED) visit for migraine headache. Brain imaging was done with no important findings. The patient was managed with pyridostigmine as a myasthenia gravis diagnosis was suspected but no response was seen. Left oculomotor palsy went on to improve gradually with a course of oral steroids; however, on her third-month follow-up, the patient developed a worsening diplopia episode revealing a new left abducens nerve palsy followed by right oculomotor and trochlear nerve palsies in a period of less than one month. An autoimmune encephalitis panel was made which came back positive for anti-GAD65. A recommendation was made to start intravenous immunoglobulin (IVIG); however, the insurance company only approved mycophenolate mofetil which went on to mitigate the aforementioned palsies. Our case supports the efficacy of steroids and mycophenolate mofetil as reasonable immunomodulators for GAD65-associated neurological syndromes. However, further research is needed to determine the best appropriate treatment approach.

PMID:39781171 | PMC:PMC11709423 | DOI:10.7759/cureus.75375


Source: https://pubmed.ncbi.nlm.nih.gov/3978117 ... t9+e462414