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OBJECTIVE: Clinical and immunological evaluation of 'incomplete' Bickerstaff brainstem encephalitis (BBE). METHODS: We studied two patients with postinfectious brainstem syndromes who presented at National University Hospital Singapore. Laboratory work-up included measurement of antiganglioside antibodies. RESULTS: Both patients displayed hypersomnolence and cerebellar-like ataxia in the absence of external ophthalmoplegia and carried high serum titres of IgG anti-GQ1b antibodies, strongly indicative of BBE. CONCLUSIONS: Ophthalmoplegia can be absent or incomplete in BBE, and the absence of this clinical feature should not exclude BBE from the clinicians' differential. Such cases of incomplete BBE could be defined as 'ataxic hypersomnolence without ophthalmoplegia'.

Original publication

DOI

10.1136/jnnp-2013-304993

Type

Journal article

Journal

J Neurol Neurosurg Psychiatry

Publication Date

11/2013

Volume

84

Pages

1206 - 1207

Keywords

EYE MOVEMENTS, GUILLAIN-BARRE SYNDROME, IMMUNOLOGY, NEUROPATHY, Adult, Autoantibodies, Brain Stem, Cerebellar Ataxia, Disorders of Excessive Somnolence, Encephalitis, Female, Follow-Up Studies, G(M1) Ganglioside, Gangliosides, Humans, Immunization, Passive, Middle Aged, Neurologic Examination, Ophthalmoplegia