title: A case of fisher-bickerstaff syndrome overlapped by guillain-barré syndrome.
abstract: We report a 72-year-old woman with overlapping Miller Fisher syndrome (MFS), Guillain-Barré syndrome (GBS) and Bickerstaff's brainstem encephalitis (BBE). She developed diplopia and unsteady gait a week after an upper respiratory infection on day 1. She had weakness of both upper limbs on day 3 and became drowsy, and her respiratory status worsened on day 5. Neurologic examination revealed ophthalmoplegia, ataxia, symmetrical weakness, areflexia, and consciousness disturbance. We diagnosed her with MFS on day 1, GBS on day 3 and overlapping BBE on day 5. She underwent immunoadsorption therapy and two courses of intravenous immunoglobulin therapy. Ten months after onset, her symptoms had fully recovered. Anti-GM1 IgG, GD1a IgG, GQ1b IgG, and GT1a IgG antibodies were positive. Our case supports the notion that MFS, GBS, and BBE are all part of a continuous clinical spectrum, which is an antibody-mediated process.
authors.affiliation: Department of Neurology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Fujii
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Manabe
authors.forename: Yosiaki
authors.initials: Y
authors.lastname: Takahasi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Narai
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Omori
authors.forename: Susumu
authors.initials: S
authors.lastname: Kusunoki
authors.forename: Koji
authors.initials: K
authors.lastname: Abe
keywords: Bickerstaff's brainstem encephalitis; Guillain-Barré syndrome; Miller Fisher syndrome