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A case of the subacute brainstem encephalitis.

A Taraszewska1, A Piekarska, M Kwiatkowski

  • 1Department of Neuropathology, Polish Academy of Sciences, Warszawa.

Folia Neuropathologica
|March 18, 1999
PubMed
Summary

This case report details a fatal brainstem encephalitis in a 66-year-old woman. Neuropathology revealed significant T and B lymphocyte infiltration in the brainstem, despite normal initial diagnostic tests.

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Area of Science:

  • Neuropathology
  • Neuroimmunology
  • Clinical Neurology

Background:

  • Brainstem encephalitis presents a diagnostic challenge, often with unclear etiology.
  • Early clinical signs can include cranial nerve palsies and ataxia, progressing to severe neurological deficits.

Observation:

  • A 66-year-old woman presented with acute abducens palsy, nystagmus, and ataxia, rapidly progressing to paralysis of eye movements, dysphagia, and hemiparesis.
  • Cerebrospinal fluid, CT, and MRI scans were unremarkable, complicating the initial diagnosis.
  • The patient succumbed to the illness four months after symptom onset.

Findings:

  • Post-mortem neuropathological examination revealed extensive perivascular and nodular inflammatory infiltrates, predominantly T and B lymphocytes, within the brainstem.

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  • Inflammation was most severe in the midbrain and pontine tegmentum, sparing the basal ganglia and cerebral/cerebellar cortices.
  • Immunohistochemistry excluded common viral etiologies (HSV-1, EBV, CMV) and paraneoplastic syndromes.

    • Implications:

    • This case highlights the difficulty in diagnosing and treating brainstem encephalitis of undetermined etiology.
    • The neuropathological findings suggest an autoimmune or inflammatory process targeting the brainstem.
    • Further research is needed to identify novel causes and therapeutic strategies for such devastating neurological conditions.