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Delirium in two patients with Bickerstaff's brainstem encephalitis
Yuko Wada1, Chie Yanagihara, Yo Nishimura
1Department of Neurology, Nishi-Kobe Medical Center, Hyogo, Japan. wada@nmc-kobe.org
Journal of the Neurological Sciences
|March 19, 2008
Summary
Bickerstaff
Area of Science:
- Neurology
- Immunology
Background:
- Bickerstaff's brainstem encephalitis (BBE) is a rare neurological disorder.
- It is characterized by ophthalmoplegia, ataxia, and altered consciousness.
Observation:
- Two patients with BBE presented with unusual psychiatric symptoms, including emotional incontinence, restlessness, and aggression from disease onset.
- Both patients had elevated serum anti-GQ1b and anti-GT1a IgG antibodies.
Findings:
- Brain MRI was normal in both patients.
- Single-photon emission computed tomography (SPECT) revealed reversible hypoperfusion in the brainstem, thalami, and medial frontal lobe in one patient.
- The findings suggest SPECT's utility in detecting BBE-related brain lesions.
Implications:
- Neurologists should consider BBE in patients with acute ophthalmoplegia, ataxia, and unusual psychiatric symptoms.
- Early diagnosis and recognition of BBE are crucial for appropriate management.
- Brain SPECT may aid in the diagnosis and understanding of BBE pathophysiology.
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