title: [A case report of Bickerstaff's brainstem encephalitis with positive anti GQ 1 b, GT 1 a, GM 1 ganglioside antibodies].
abstract: Patient was an 18-year-old female student. After she had symptoms of common cold for 3 days, she developed somnolence, diplopia, dysarthria, urinary disturbance and ataxia. On admission neurological examination revealed coma with mydriasis, ophthalmoplegia, ptosis and weakness of the upper limbs. Light reflex, corneal reflex and oculocephalic test were all negative. Deep tendon reflexes were brisk and extensor toe signs were positive bilaterally. She did not have nuchal rigidity. Laboratory test revealed normal cerebrospinal fluid with negative myelin basic protein. Brain MRI, brainstem evoked potentials presented no abnormality. EMG revealed normal conduction velocity and no conduction block. EEG had diffuse theta and delta slowing. Culture of the stool represented no Campylobacter jejuni. At the fifth day of admission consciousness level improved, and other neurological findings disappeared in about 6 weeks. She had anti GQ 1 b, GT 1 a(IgG, IgM) and anti GM 1(IgM) antibodies in the serum. We made a diagnosis of Bickerstaff's brainstem encephalitis from these neurological symptoms and clinical course. The main lesion was present in the brainstem from midbrain to medulla oblongata in the midline. High titer of anti GT 1a antibody may be related to the ophthalmoplegia as noted in Miller Fisher syndrome. As a result of EMG and stool culture, it denied the complication of Guillain-Barré syndrome. We had no proof of the reason of the presentation of anti GM 1 antibody.
authors.affiliation: Fourth Department of Internal Medicine, Toho University, School of Medicine, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Nemoto
authors.forename: M
authors.initials: M
authors.lastname: Kishi
authors.forename: T
authors.initials: T
authors.lastname: Ogawa
authors.forename: T
authors.initials: T
authors.lastname: Kurihara
authors.forename: M
authors.initials: M
authors.lastname: Kinoshita
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000097:blood*; D001933:Brain Stem; D004268:DNA-Binding Proteins / Q000276:immunology*; D004660:Encephalitis / Q000276:immunology* / Q000503:physiopathology; D005260:Female; D005677:G(M1) Ganglioside / Q000276:immunology*; D043802:GTP-Binding Protein alpha Subunits, Gq-G11; D020962:Heterotrimeric GTP-Binding Proteins / Q000276:immunology*; D006801:Humans; D010940:Plant Proteins / Q000276:immunology*
chemical_list: D000906:Antibodies; D004268:DNA-Binding Proteins; D010940:Plant Proteins; C077485:GT-1a protein, Nicotiana tabacum; D005677:G(M1) Ganglioside; D043802:GTP-Binding Protein alpha Subunits, Gq-G11; D020962:Heterotrimeric GTP-Binding Proteins