An Unusual Presentation of Bickerstaff Brainstem Encephalitis

Abstract

Bickerstaff brainstem encephalitis (BBE) is diagnosed by progressive, relatively symmetrical ophthalmoplegia, ataxia, disturbance
of consciousness and/or hyperreflexia. Positive anti-GQ1b are found in 66% and abnormal brain MRI in 30% of patients. The
classical triad seen in Fisher syndrome is ataxia, ophthalmoplegia and areflexia. If there is associated alteration in the level of
consciousness and/or hyperreflexia, a diagnosis of Bickerstaff encephalitis is made due to possible involvement of the central
nervous system. Here we report a case of BBE presenting with hyperreflexia without drowsiness as a sign of CNS involvement.