jsmc-10080
Case Report
A CASE OF BICKERSTAFF’S BRAINSTEM ENCEPHALITIS IN CHILDHOOD
Khalid Hama Salih *
* Department of Pediatrics, School of Medicine, Faculty of Medical Sciences, University.
Submitted: 3/9/2014; Accepted: 1/4/2015; Published 1/12/2015
DOI Link: https://doi.org/10.17656/jsmc.10080
ABSTRACT
Bickerstaff’s brainstem encephalitis is characterized by acute progressive ophthalmoplegia, ataxia, and disturbance of consciousness. It is similar to Miller Fisher syndrome, a variant of Guillain-Barre syndrome, because they have some features in common like; ophthalmoplegia and ataxia. The difference is that patients with Bickerstaff’s brainstem encephalitis have impaired consciousness and hyperreflexia while patients with Miller Fisher syndrome have alert consciousness and areflexia.
Here, we present a case 4 year and 3 month old girl with abrupt onset ophthalmoplegia, ataxia and disturbed consciousness, her brain Magnetic Resonance Imaging (MRI) was normal, cerebrospinal fluid analysis showed albuminocytological dissociation, and Nerve conduction study is suggestive of Acute Inflammatory Demyelinating-axonal motor polyneuropathy (AIDP). She has been treated successfully with steroid with complete recovery within two months.
KEYWORDS
Encephalitis, Bickerstaff’s, Brain stem, Complete recovery.
References
1. Al-Din AN, Anderson M, Bickerstaff ER, Harvey I. Brainstem encephalitis and the syndrome of Miller Fisher: a clinical study. Brain : a journal of neurology. 1982;105 (Pt 3):481-95.
2. Odaka M, Yuki N, Yamada M, Koga M, Takemi T, Hirata K, et al. Bickerstaff’s brainstem encephalitis: clinical features of 62 cases and a subgroup associated with Guillain-Barre syndrome. Brain : a journal of neurology. 2003;126 (Pt 10):2279-90.
3. Bickerstaff ER, Cloake PC. Mesencephalitis and rhombencephalitis. British medical journal. 1951;2(4723):77-81.
4.Fisher M. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). The New England journal of medicine. 1956;255(2):57-65.
5. Falini A, Kesavadas C, Pontesilli S, Rovaris M, Scotti G. Differential diagnosis of posterior fossa multiple sclerosis lesions--neuroradiological aspects. Neurological sciences. 2001;22 Suppl 2:S79-83.
6. Belshe RB. Implications of the emergence of a novel H1 influenza virus. The New England journal of medicine. 2009;360(25):2667-8.
7. Williams MH. The spectrum of IgG GQ1(b) syndrome: an unusual cluster. Journal of clinical neuroscience. 2001;8(4):315-8.
8. Ozawa T, Onodera O, Inuzuka T, Soma Y, Tsuji S. Efficacy of early plasmapheresis in Bickerstaff’s encephalitis. Intern Med. 1998;37(11):986-9.
9. Odaka M, Yuki N, Hirata K. Anti-GQ1b IgG antibody syndrome: clinical and immunological range. Journal of neurology, neurosurgery, and psychiatry. 2001;70(1):50-5.
10. Yaqub BA, al-Deeb SM, Daif AK, Sharif HS, Shamena AR, al-Jaberi M, et al. Bickerstaff brainstem encephalitis. A grave non-demyelinating disease with benign prognosis. Journal of the neurological sciences. 1990;96(1):29-40.
11. Mondejar RR, Santos JM, Villalba EF. MRI findings in a remitting-relapsing case of Bickerstaff encephalitis. Neuroradiology. 2002;44(5):411-4.