Short reportOverlap of Guillain-Barré syndrome and Bickerstaff's brainstem encephalitis
Introduction
Bickerstaff's brainstem encephalitis (BBE) is characterized by acute ophthalmoplegia and ataxia (Bickerstaff and Cloake, 1951; Bickerstaff, 1957). Some patients with BBE show drowsiness, brisk reflexes, extensor plantar responses, hemisensory disturbance, or CSF pleocytosis. Bickerstaff and Cloake (1951)speculated that the etiology of BBE is similar to that of Guilllain-Barré syndrome (GBS) because areflexia and CSF albumino-cytologic dissociation was detected in one of their two patients. The nosological relationship between BBE and GBS has yet, however, to be established (Al-Din, 1987) because no pathological findings of overlapping cases of BBE and GBS have been reported. We here report the autopsy results for a patient for whom the diagnosis was overlapping BBE and GBS and speculate on the nosological relationship between GBS and BBE.
Section snippets
Case report
A 71-year-old woman suffered coughing and fever which abated over a period of few days. One week after the resolution of this illness, she experienced diplopia and was admitted to a hospital on day 1. Neurologic examinations showed left blepharoptosis and mydriasis. On day 6, during an otolaryngological examination of her larynx and pharynx, because of aspiratory dyspnea, she suddenly developed cardiac arrest. She was intubated and placed on a respirator. Because subarachinoidal hemorrhage was
Discussion
Subsequent to upper respiratory infection, the patient rapidly developed ophthalmoplegia, limb weakness, and areflexia. Neurophysiologic findings indicated motor nerve dysfunction. She showed drowsiness associated with CSF pleocytosis and had an EEG abnormality. The clinical diagnosis was overlapping GBS and BBE. Our patient had rigidity in the recovery phase, which has been described in some patients with BBE (Bickerstaff, 1957). Transient cardiac arrest may have been a factor in the
Acknowledgements
This research was supported in part by a Research Grant for Neuroimmunological Diseases from the Ministry of Health and Welfare of Japan.
References (9)
- et al.
Clinical signs of brain death simulated by Guillain-Barré syndrome
J Neurol Sci
(1993) - et al.
An immunologic abnormality common to Bickerstaff's brain stem encephalitis and Fisher's syndrome
J Neurol Sci
(1993) The nosological position of the ophthalmoplegia, ataxia and areflexia syndrome: “The spectrum hypothesis”
Acta Neurol Scand
(1987)- et al.
Mesencephalitis and rhombencephalitis
Br Med J
(1951)