Bickerstaff's brainstem encephalitis: can it recur?
Bickerstaff's brain-stem encephalitis is usually a monophasic post-viral inflammatory illness characterized by progressive ophthalmoplegia, ataxia and disturbance of consciousness (or hyper-reflexia). Since the clinical spectrum of Bickerstaff encephalitis may overlap with the Miller-Fisher and Guillain-Barré syndromes, the presence of anti- GQ1b antibodies and abnormal brain MRI can help to support its diagnosis. However, absence of anti-GQ1b antibodies and normal MRI do not exclude the diagnosis, which remains based on clinical criteria and exclusion of other etiologies. We report a case of recurrent Bickerstaff's brainstem encephalitis with no identifiable antecedent illness, and overlapping features of Miller Fisher and Guillain-Barré syndromes, in the presence of negative anti-GQ1b antibodies and repeatedly normal MRI of the brain.
Sharma
Vijay
V
Division of Neurology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
Chan
Y C
YC
Ong
Teoh
H L
HL
Wilder-Smith
E P
EP
D001933:Brain Stem; D003243:Consciousness; D004569:Electroencephalography; D004660:Encephalitis / Q000503:physiopathology*; D005732:Gangliosides / Q000032:analysis / Q000276:immunology; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D019846:Miller Fisher Syndrome / Q000150:complications; D009460:Neurologic Examination; D009886:Ophthalmoplegia / Q000209:etiology; D010243:Paralysis / Q000209:etiology; D026741:Physical Therapy Modalities; D012008:Recurrence
D005732:Gangliosides; C039129:GQ1b ganglioside