title: Atypical Bickerstaff brainstem encephalitis: ataxic hypersomnolence without ophthalmoplegia.
abstract: OBJECTIVE
  Clinical and immunological evaluation of 'incomplete' Bickerstaff brainstem encephalitis (BBE).
  
  
  METHODS
  We studied two patients with postinfectious brainstem syndromes who presented at National University Hospital Singapore. Laboratory work-up included measurement of antiganglioside antibodies.
  
  
  RESULTS
  Both patients displayed hypersomnolence and cerebellar-like ataxia in the absence of external ophthalmoplegia and carried high serum titres of IgG anti-GQ1b antibodies, strongly indicative of BBE.
  
  
  CONCLUSIONS
  Ophthalmoplegia can be absent or incomplete in BBE, and the absence of this clinical feature should not exclude BBE from the clinicians' differential. Such cases of incomplete BBE could be defined as 'ataxic hypersomnolence without ophthalmoplegia'.
authors.affiliation: Department of Medicine, National University Hospital, , Singapore, Singapore.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Wakerley
authors.forename: Derek
authors.initials: D
authors.lastname: Soon
authors.forename: Yee-Cheun
authors.initials: YC
authors.lastname: Chan
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Yuki
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood; D001933:Brain Stem; D002524:Cerebellar Ataxia / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D004660:Encephalitis / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005677:G(M1) Ganglioside / Q000276:immunology; D005732:Gangliosides / Q000276:immunology; D006801:Humans; D007116:Immunization, Passive; D008875:Middle Aged; D009460:Neurologic Examination; D009886:Ophthalmoplegia / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy
chemical_list: D001323:Autoantibodies; D005732:Gangliosides; C021298:ganglioside, GD1a; D005677:G(M1) Ganglioside; C039129:GQ1b ganglioside
keywords: EYE MOVEMENTS; GUILLAIN-BARRE SYNDROME; IMMUNOLOGY; NEUROPATHY