SHM Converge Scientific Abstract ePoster Gallery-Acute Bickerstaff Brainstem Encephalitis in a Middle-Aged Male: Diagnostic Challenges and Therapeutic Response

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This case report describes a 40-year-old man who presented with acute dizziness, visual disturbance, and gait instability. On examination, he had bilateral sixth nerve palsies, a left third nerve palsy, ophthalmoplegia, and dysmetria, raising concern for a brainstem process. Brain MRI was normal, but cerebrospinal fluid showed lymphocytic pleocytosis, and anti-GQ1b antibodies were elevated, supporting the diagnosis of Bickerstaff brainstem encephalitis (BBE).<br /><br />BBE is a rare autoimmune demyelinating disorder within the Fisher-Bickerstaff syndrome spectrum. It typically presents with ophthalmoplegia, ataxia, and altered mental status, and it can overlap clinically with Guillain-Barré syndrome and Miller Fisher syndrome. The condition is often associated with anti-GQ1b antibodies and may follow infections through molecular mimicry, including Campylobacter jejuni and SARS-CoV-2.<br /><br />The patient was treated with intravenous immunoglobulin (IVIG) for four days and showed significant improvement. He was discharged to acute rehabilitation with only mild residual dizziness. This favorable response highlights the importance of early recognition and treatment.<br /><br />The report emphasizes that BBE is frequently misdiagnosed because its symptoms can mimic other neurologic disorders. Normal imaging does not exclude the diagnosis, so clinicians should rely on clinical findings, CSF analysis, and antibody testing when available. Anti-GQ1b antibodies are a key diagnostic marker, and IVIG remains an effective therapy.<br /><br />Overall, the case underscores the need for greater clinician awareness of BBE to prevent delayed diagnosis and improve outcomes.

Asset Subtitle

Diana Aiti

Meta Tag

Author List Ameed Bawaab, Chanakya Kodishala, Danny Aiti, Diana Aiti, Lana Khatib, Lewis Humble

Category Clinical Vignettes

Concept Bickerstaff Brainstem Encephalitis

Concept Ophthalmoplegia

Concept Ataxia

Concept Altered Mental Status

Concept Brainstem

Distinguished Finalist

Presenter Organization Canton Medical Education Foundation/Northeast Ohio Medical University

Presenting Author Diana Aiti

Track Adult

Keywords

Bickerstaff brainstem encephalitis

anti-GQ1b antibodies

ophthalmoplegia

ataxia

brainstem encephalitis

intravenous immunoglobulin

lymphocytic pleocytosis

Miller Fisher syndrome

Guillain-Barré syndrome

acute dizziness

Bickerstaff Brainstem Encephalitis

Ophthalmoplegia

Ataxia

Altered Mental Status

Brainstem