Clinical deterioration in Bickerstaff's brainstem encephalitis caused by overlapping Guillain-Barré syndrome.
A 37-year-old man developed an acute encephalitic condition after respiratory infection. His condition rapidly deteriorated, and he experienced ophthalmoplegia, tetraplegia, loss of brainstem reflexes and deep tendon reflexes, and deep coma. Electrophysiological evaluations indicated involvement of the peripheral nerve as well as the brainstem. Follow-up studies found acute progression of peripheral nerve damage. Serum anti-GQ1b IgG antibody was present. The initial condition was diagnosed as Bickerstaff's brainstem encephalitis, and subsequent overlapping of Guillain-Barré syndrome probably was responsible for the clinical deterioration. When unusual worsening is observed in clinically suspected encephalitis, neurologists must take into account the possibility of associated Guillain-Barré syndrome and related disorders.
Susuki
Keiichiro
K
Department of Neurology, Medical Center, Yokohama City University, Yokohama, Japan. KSusuki@aol.com
Johkura
Ken
K
Yuki
Nobuhiro
N
Kuroiwa
Yoshiyuki
Y
D000328:Adult; D000906:Antibodies / Q000378:metabolism; D015153:Blotting, Western; D001927:Brain Diseases / Q000209:etiology* / Q000276:immunology; D004594:Electrophysiology / Q000379:methods; D004660:Encephalitis / Q000209:etiology* / Q000276:immunology; D005072:Evoked Potentials, Auditory / Q000502:physiology; D005500:Follow-Up Studies; D005732:Gangliosides / Q000276:immunology; D020275:Guillain-Barre Syndrome / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D009431:Neural Conduction; D009886:Ophthalmoplegia / Q000276:immunology / Q000503:physiopathology; D011782:Quadriplegia / Q000276:immunology / Q000503:physiopathology
D000906:Antibodies; D005732:Gangliosides; C039129:GQ1b ganglioside