A case of Bickerstaff brainstem encephalitis associated with spindle coma and decorticate posture

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  • Shimozono Koji
    Department of Internal Medicine, Ootemachi Hospital
  • Shimono Kenshin
    Department of Internal Medicine, Ootemachi Hospital Department of Emergency Medicine, Kagoshima City Hospital
  • Kusunoki Susumu
    Department of Neurology, Kinki University School of Medicine

Bibliographic Information

Other Title
  • 除皮質硬直姿勢を呈したspindle comaから完全回復したBickerstaff脳幹脳炎の若年男性の1例
  • 症例報告 除皮質硬直姿勢を呈したspindle comaから完全回復したBickerstaff脳幹脳炎の若年男性の1例
  • ショウレイ ホウコク ジョヒシツ コウチョク シセイ オ テイシタ spindle coma カラ カンゼン カイフク シタ Bickerstaff ノウカン ノウエン ノ ジャクネン ダンセイ ノ 1レイ
  • Case of Bickerstaff brainstem encephalitis associated with spindle coma and decorticate posture

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Description

A 25-years-old man experienced fever and diarrhea. Ten days later he noticed difficulty walking (day 1). On admission neurological examination revealed lethargy, dysarthria and weakness of limbs. Oculocephalic response was not be elicited and extensor toe signs were positive. In spite of treatment with aciclovir and methylprednisolone, he continued to show progressive deterioration developing to coma with decorticate posture. Autonomic symptoms (hyperhidrosis, hypersalivation and fever) and groaning were observed. Brain magnetic resonance image and brainstem evoked potential presented no abnormality, but electroencephalographic study showed a spindle pattern indicating spindle coma. Laboratory tests including cerebrospinal fluids showed no specific results. High-dose immunoglobulin was administered from day 6, and his consciousness level improved. External ophthalomoplegia and ataxic gait were observed after he became more alert. Because he had IgG type anti-GQ1b antibodies in the serum, a diagnosis was made of Bickerstaff's brainstem encephalitis (BBE). Six months after discharge he had complete resolution of his symptoms. This is the first report of spindle coma observed in a case of serologically confirmed BBE.<br>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 52 (9), 656-659, 2012

    Societas Neurologica Japonica

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