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A case of Bickerstaff's brainstem encephalitis mimicking tetanus
  1. T SAITO,
  2. I MIYAI,
  3. T MATSUMURA,
  4. S NOZAKI,
  5. J KANG
  1. Department of Neurology, Toneyama National Hospital 5–1–1Toneyama, Toyonaka, Osaka 560–8552, Japan
  2. Department of Pediatrics, Osaka University Medical School
  3. Division of Advanced Medical Bacteriology, Graduate School of Medicine, Osaka University
  4. Department of Neurology, Dokkyo University School of Medicine
  1. Dr Toshio Saito saitot{at}toneyama.hosp.go.jp
  1. H FUJITA
  1. Department of Neurology, Toneyama National Hospital 5–1–1Toneyama, Toyonaka, Osaka 560–8552, Japan
  2. Department of Pediatrics, Osaka University Medical School
  3. Division of Advanced Medical Bacteriology, Graduate School of Medicine, Osaka University
  4. Department of Neurology, Dokkyo University School of Medicine
  1. Dr Toshio Saito saitot{at}toneyama.hosp.go.jp
  1. N SUGIMOTO
  1. Department of Neurology, Toneyama National Hospital 5–1–1Toneyama, Toyonaka, Osaka 560–8552, Japan
  2. Department of Pediatrics, Osaka University Medical School
  3. Division of Advanced Medical Bacteriology, Graduate School of Medicine, Osaka University
  4. Department of Neurology, Dokkyo University School of Medicine
  1. Dr Toshio Saito saitot{at}toneyama.hosp.go.jp
  1. N YUKI
  1. Department of Neurology, Toneyama National Hospital 5–1–1Toneyama, Toyonaka, Osaka 560–8552, Japan
  2. Department of Pediatrics, Osaka University Medical School
  3. Division of Advanced Medical Bacteriology, Graduate School of Medicine, Osaka University
  4. Department of Neurology, Dokkyo University School of Medicine
  1. Dr Toshio Saito saitot{at}toneyama.hosp.go.jp

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Bickerstaff's brainstem encephalitis is characterised by acute ophthalmoplegia and ataxia with progressive consciousness disturbance.1 Although Bickerstaff described rigidity in the recovery phase,1 rigidity in the clinical course of Bickerstaff's brainstem encephalitis has rarely been reported.2 We encountered a case in which the initial diagnosis was tetanus, because of the progression of severe rigidity and risus sardonicus, but which turned out to be Bickerstaff's brainstem encephalitis owing to the presence of anti-GQ1b IgG antibody.

A 23 year old man who had had no prior apparent infectious episode began to show dysaesthesia, clumsiness, and slight weakness of all limbs (day 1). Due to rapid exacerbation of these symptoms he was admitted to a hospital the next day. On day 3, he became irritable because of increased anxiety, although he was alert and completely oriented. He was transferred to another hospital for further treatment. There he required assistance in walking because of new severe rigidity in all his limbs. Oral haloperidol (maximum dose 20 mg/day) was given for 10 days to reduce his anxiety, but his symptoms did not lessen. Treatment with intravenous methylprednisolone (1000 mg/day) from day 14 to 16, as well as acyclovir (1500 mg/day) given …

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