Neurológia pre prax 2/2017

Bickerstaff's autoimmune brainstem encephalitis

Bickerstaff´s autoimmune brainstem encefalitis (BBE) is, together with Miller-Fisher syndrome (MFS) and Guillain-Barré syndrome (GBS), subdued as one of the autoimmune associated diseases affecting the nervous system. In case of Bickerstaff´s encephalitis the structure affected by inflammation is the brainstem, with the corresponding clinical features . We report a case of 60-year-old female patient who developed, within a few months a gait disturbance, paleocerebellar and neocerebellar symptoms, internuclear ophalmoplegia with dissociated nystagmus, bilateral nuclear lesion of the facial nerve and bulbar symptoms. Magnetic resonance (MR) imaging of the brain revealed multiple non-specific lesions in supra-tentorial localisation and in the brainstem. The examination of the cerebrospinal fluid exposed lymphocellular pleocytosis and increased proteinorhachia. By all of the other available paraclinical examination methods we were not able to find other possible cause and the case was closed with the diagnose of Bickerstaff´s autoimmune brainstem encephalitis.

Keywords: Bickerstaff, Guillain-Barré syndrome, autoimmune encefalitis, brainstem encefalitis