title: Bickerstaff's brainstem encephalitis presenting to the ICU.
abstract: BACKGROUND
  Bickerstaff's brainstem encephalitis continues to pose a diagnostic and treatment challenge since the original descriptions by Bickerstaff and Miller-Fisher. The clinical syndrome overlaps with AIDP and MFS, but is accompanied by decreased level of consciousness not attributable to other causes, and the variable presence of long-tract signs.
  
  
  METHODS
  The methods in this study include the case presentation with autopsy findings of an elderly male presented with progressive weakness and impairment of consciousness and the literature review.
  
  
  RESULTS
  Examination revealed areflexia and loss of most brainstem reflexes. Some improvement occurred after several weeks in the ICU, prior to death from pulmonary embolism. Pathologic specimens were similar to others in the literature, with inflammatory changes in nerve roots and brainstem.
  
  
  CONCLUSIONS
  The above findings led us to conclude that Bickerstaff's brainstem encephalitis remains a clinical diagnosis despite advances in electrophysiologic testing and neuroimaging. BBE likely represents part of a spectrum, overlapping with AIDP and MFS. Immunomodulation may be helpful in shortening the clinical course.
authors.affiliation: Division of Neurology, Department of Medicine, University of Saskatchewan, 112 3502 Taylor St. E., Saskatoon, SK, S7V 1J1, Canada. grwhunter@gmail.com
authors.forename: Gary
authors.initials: G
authors.lastname: Hunter
authors.forename: G Bryan
authors.initials: GB
authors.lastname: Young
authors.forename: Lee Cyn
authors.initials: LC
authors.lastname: Ang
mesh_terms: D000369:Aged, 80 and over; D001933:Brain Stem / Q000473:pathology*; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000175:diagnosis* / Q000628:therapy*; D017809:Fatal Outcome; D006801:Humans; D008297:Male