Bickerstaff's brainstem encephalitis complicating Salmonella Paratyphi A infection

Patients with enteric fever frequently develop neurological complications during their illness. Among them, majority has encephalopathy, but focal deficits or peripheral nervous involvements are occasionally encountered. We describe a young woman who developed a neurological syndrome consistent with Bickerstaff's brainstem encephalitis, with symptoms and signs including convulsion, impaired consciousness, external ophthalmoplegia, ataxia, bulbar palsy and pyramidal signs, following Salmonella Paratyphi A infection. This is the first case report of this syndrome after S. Paratyphi A infection, and it is the second case of Bickerstaff's brainstem encephalitis complicating enteric fever reported in the literature. This case also demonstrated, for the first time, a positive anti-GQ1b IgG response in a patient with Bickerstaff's brainstem encephalitis and related disorders that appear as complications during enteric fever.