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Bickerstaff's brainstem encephalitis: can it recur?

Vijay Sharma1, Y C Chan, Ong

  • 1Division of Neurology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|January 31, 2006
PubMed

Insights

Bickerstaff's brainstem encephalitis can recur and present atypically. This case highlights recurrent Bickerstaff encephalitis with overlapping syndromes, normal MRI, and negative anti-GQ1b antibodies, challenging typical diagnostic criteria.

Area of Science:

  • Neurology
  • Neuroimmunology
  • Inflammatory Brainstem Encephalitis

Background:

  • Bickerstaff's brainstem encephalitis (BBE) is typically a monophasic post-viral inflammatory condition.
  • BBE often presents with ophthalmoplegia, ataxia, and consciousness disturbances.
  • Diagnostic support includes anti-GQ1b antibodies and brain MRI, though their absence doesn't exclude BBE.

Observation:

  • This report details a rare case of recurrent Bickerstaff's brainstem encephalitis.
  • The patient exhibited overlapping clinical features of Miller Fisher Syndrome and Guillain-Barré Syndrome.
  • Crucially, the patient had no identifiable antecedent illness, negative anti-GQ1b antibodies, and normal brain MRIs.

Findings:

  • Recurrent BBE can occur without a clear preceding illness.
  • Clinical presentation can mimic or overlap with other autoimmune neuropathies.
  • Diagnostic certainty for BBE may rely on clinical criteria and exclusion, even with atypical serological and imaging findings.

Implications:

  • This case expands the known clinical spectrum of Bickerstaff's brainstem encephalitis.
  • It underscores the importance of considering BBE in recurrent neurological presentations, even with negative biomarkers.
  • Highlights the need for careful clinical evaluation and differential diagnosis in complex autoimmune neurological disorders.

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