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Lee SU, Kim HJ, Choi JY, Choi KD, Kim JS. Expanding Clinical Spectrum of Anti-GQ1b Antibody Syndrome: A Review. JAMA Neurol 2024:2818518. [PMID: 38739407 DOI: 10.1001/jamaneurol.2024.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Importance The discovery of the anti-GQ1b antibody has expanded the nosology of classic Miller Fisher syndrome to include Bickerstaff brainstem encephalitis, Guillain-Barré syndrome with ophthalmoplegia, and acute ophthalmoplegia without ataxia, which have been brought under the umbrella term anti-GQ1b antibody syndrome. It seems timely to define the phenotypes of anti-GQ1b antibody syndrome for the proper diagnosis of this syndrome with diverse clinical presentations. This review summarizes these syndromes and introduces recently identified subtypes. Observations Although ophthalmoplegia is a hallmark of anti-GQ1b antibody syndrome, recent studies have identified this antibody in patients with acute vestibular syndrome, optic neuropathy with disc swelling, and acute sensory ataxic neuropathy of atypical presentation. Ophthalmoplegia associated with anti-GQ1b antibody positivity is complete in more than half of the patients but may be monocular or comitant. The prognosis is mostly favorable; however, approximately 14% of patients experience relapse. Conclusions and Relevance Anti-GQ1b antibody syndrome may present diverse neurological manifestations, including ophthalmoplegia, ataxia, areflexia, central or peripheral vestibulopathy, and optic neuropathy. Understanding the wide clinical spectrum may aid in the differentiation and management of immune-mediated neuropathies with multiple presentations.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
- Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Hyo-Jung Kim
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Deparment of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Pusan, South Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Deparment of Neurology, Seoul National University College of Medicine, Seoul, South Korea
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2
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Sicard M, Shor N, Davy V, Rouby JJ, Oquendo B, Maisonobe T, Puybasset L, Lehericy S, Lecarpentier A, Donadio C, Oasi C, Belmin J, Lubetzki C, Corvol JC, Grabli D, Saracino D. Cerebellar encephalitis and peripheral neuropathy with an atypical clinical and neuroimaging signature following Covid-19 vaccine: a report of two cases. J Neurol 2024:10.1007/s00415-024-12390-5. [PMID: 38704487 DOI: 10.1007/s00415-024-12390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Marin Sicard
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Natalia Shor
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neuroradiology, Paris, France
| | - Vincent Davy
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Jean-Jacques Rouby
- Sorbonne Université, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Paris, France
| | - Bruno Oquendo
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Thierry Maisonobe
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Louis Puybasset
- Sorbonne Université, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Paris, France
| | - Stephane Lehericy
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neuroradiology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Amandine Lecarpentier
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Cristiano Donadio
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Christel Oasi
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Joël Belmin
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Catherine Lubetzki
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - David Grabli
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Dario Saracino
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France.
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France.
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Departement of Neurology, Reference Centre for Rare or Early Dementias, Paris, France.
- Paris Brain Institute - Institut du Cerveau (ICM), AP-HP - Hôpital Pitié-Salpêtrière, DMU Neurosciences, Département de Neurologie, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
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3
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Fu X, Zhan Q, Zhang L, Tian X. Case report: Shingles-associated probable Bickerstaff brainstem encephalitis with IgM anti-sulfatide positivity. Front Immunol 2024; 15:1358886. [PMID: 38660303 PMCID: PMC11041370 DOI: 10.3389/fimmu.2024.1358886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Background Bickerstaff brainstem encephalitis (BBE) is a rare disease considered caused by acute demyelination of the brainstem, most often resulting from secondary autoimmune responses. To our knowledge, this is the first probable case report of shingles-associated BBE with anti-sulfatide IgM positivity. Case presentation We report the case of an 83-year-old woman with symptoms of progressive limb weakness, difficulty swallowing food, and disturbed consciousness that occurred 4 weeks following herpes zoster infection. Autoimmune anti-sulfatide antibodies were positive and fluid-attenuated inversion recovery (FLAIR) sequences revealed clear high signal intensity in pons and bilateral thalamus. Our patient's condition improved markedly with glucocorticoid treatment. After 2 months of treatment, our patient was fully recovered. We considered that for her case, BBE is the most appropriate diagnosis. Conclusions We emphasize the importance of a careful medical history and assessment of clinical symptoms, performing MRI, testing autoimmune antibodies for rapid diagnosis, and ruling out differential diagnoses. Further studies involving more patients with BBE with IgM anti-sulfatide autoantibodies will increase the understanding of the clinical characteristics and advance the diagnosis and treatment of this syndrome. Meanwhile, it is crucial for dermatologists to know about this severe neurological complication following shingles.
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Affiliation(s)
- Xiaoxue Fu
- Baoding First Central Hospital, Baoding, Hebei, China
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4
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Sarna MK, Shah S, Rijhwani P, Goyal G, Jain AK, Goel P. Guillain Barre syndrome mimicking brain death. J R Coll Physicians Edinb 2024:14782715241244839. [PMID: 38576167 DOI: 10.1177/14782715241244839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
A 49-year-old female patient presented at the hospital with a history of herpetic blisters, frequent episodes of vomiting and loose stools, bilateral upper and lower limb weakness, and diminishing sensorium. She was diagnosed with hyponatraemia and respiratory failure and later became unconscious with absent brainstem reflexes. The patient was initially treated for herpetic encephalitis, a chronic obstructive pulmonary disease with acute exacerbation, hyponatraemia and neuroparalytic snake bite. Further evaluation, however, identified the uncommon Guillain Barre syndrome presentation with overlap of Bickerstaff brainstem encephalitis. This is an uncommon disorder characterised by the involvement of higher mental functions, fixed dilated pupils, absent brainstem reflexes and quadriplegia that resembles a neuroparalytic snake bite and brain death. After receiving intravenous immunoglobulins for treatment, the patient completely recovered.
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Affiliation(s)
- Mukesh Kumar Sarna
- Department of General Medicine, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
| | - Sarthak Shah
- Department of General Medicine, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
| | - Puneet Rijhwani
- Department of General Medicine, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
| | - Gourav Goyal
- Department of Neurology, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
| | - Anand Kumar Jain
- Department of Organ Transplant Anaesthesia and Critical Care Medicine, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
| | - Pallaavi Goel
- Department of General Medicine, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
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5
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Gilligan M, McGuigan C, McKeon A. Autoimmune central nervous system disorders: Antibody testing and its clinical utility. Clin Biochem 2024; 126:110746. [PMID: 38462203 PMCID: PMC11016295 DOI: 10.1016/j.clinbiochem.2024.110746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/16/2024] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
A rapidly expanding repertoire of neural antibody biomarkers exists for autoimmune central nervous system (CNS) disorders. Following clinical recognition of an autoimmune CNS disorder, the detection of a neural antibody facilitates diagnosis and informs prognosis and management. This review considers the phenotypes, diagnostic assay methodologies, and clinical utility of neural antibodies in autoimmune CNS disorders. Autoimmune CNS disorders may present with a diverse range of clinical features. Clinical phenotype should inform the neural antibodies selected for testing via the use of phenotype-specific panels. Both serum and cerebrospinal fluid (CSF) are preferred in the vast majority of cases but for some analytes either CSF (e.g. N-methyl-D-aspartate receptor [NMDA-R] IgG) or serum (e.g. aquaporin-4 [AQP4] IgG) specimens may be preferred. Screening using 2 methods is recommended for most analytes, particularly paraneoplastic antibodies. We utilize murine tissue-based indirect immunofluorescence assay (TIFA) with subsequent confirmatory protein-specific testing. The cellular location of the target antigen informs choice of confirmatory diagnostic assay (e.g. blot for intracellular antigens such as Hu; cell-based assay for cell surface targets such as leucine-rich glioma inactivated 1 [LGI1]). Titers of positive results have limited diagnostic utility with the exception of glutamic acid decarboxylase (GAD) 65 IgG autoimmunity, which is associated with neurological disease at higher values. While novel antibodies are typically discovered using established techniques such as TIFA and immunoprecipitation-mass spectrometry, more recent high-throughput molecular technologies (such as protein microarray and phage-display immunoprecipitation sequencing) may expedite the process of antibody discovery. Individual neural antibodies inform the clinician regarding the clinical associations, oncological risk stratification and tumor histology, the likely prognosis, and immunotherapy choice. In the era of neural antibody biomarkers for autoimmune CNS disorders, access to appropriate laboratory assays for neural antibodies is of critical importance in the diagnosis and management of these disorders.
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Affiliation(s)
- Michael Gilligan
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | | | - Andrew McKeon
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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6
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Aninang MT, Baltazar-Libiran MR, Damian LF. Utility of Brainstem Auditory Evoked Response as a Diagnostic Tool and Rituximab as a Treatment for Severe Bickerstaff Brainstem Encephalitis: A Case Report. Cureus 2024; 16:e57993. [PMID: 38738130 PMCID: PMC11088453 DOI: 10.7759/cureus.57993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/14/2024] Open
Abstract
Bickerstaff brainstem encephalitis (BBE) is a rare disorder that is characterized by ophthalmoplegia, ataxia, and disturbance in consciousness. Definite diagnosis is made primarily through clinical presentation and serology testing with anti-GQ1b antibody. However, in a country where access to serologic testing is scarce, electrophysiologic tests such as brainstem auditory evoked response (BAER) may contribute to the diagnosis. Due to its rarity and generally good prognosis, there is no established consensus for the treatment of BBE. Immunomodulatory treatments such as intravenous immunoglobulin (IVIG), plasma exchange, steroids, or a combination of these therapies are often used with good response. However, there are severe cases that respond poorly to these conventional treatments. We report the case of a 26-year-old Filipino man who came in for sudden onset of diplopia, with a one-week history of upper respiratory tract infection. Subsequently, he developed paresthesias, quadriparesis, and an altered level of consciousness. On initial examination, he only had partial third nerve palsy, but eventually became quadriparetic and obtunded during admission. Initial electromyography and nerve conduction velocity (EMG-NCV) study showed a reduced recruitment pattern of the right rectus femoris, absent H reflexes of bilateral posterior tibial nerves, and no abnormal increase in temporal dispersion. Cranial MRI with contrast was unremarkable. Video electroencephalogram (video-EEG) showed intermittent generalized 5-6 Hz and 6-7 Hz theta slowing of the background activity in the stimulated state. BAER was done revealing bilateral partial dysfunction of the auditory pathways to support brainstem involvement of the disease. He received IVIG and methylprednisolone pulse therapy with no significant clinical improvement. Hence, he was given a rituximab infusion. One week post-rituximab, he had sustained wakefulness and was able to move his extremities.
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Affiliation(s)
- Myra T Aninang
- Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, PHL
| | | | - Ludwig F Damian
- Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, PHL
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7
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Ciarletta J, Weinstock-Guttman B, Thapa S, Mirmosayyeb O, Awan S, Eckert S. Bickerstaff brain stem encephalitis preceding recurrent myelin oligodendrocyte glycoprotein antibody-associated disease. Acta Neurol Belg 2024:10.1007/s13760-024-02528-7. [PMID: 38498264 DOI: 10.1007/s13760-024-02528-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Affiliation(s)
- John Ciarletta
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St, Buffalo, NY, 14203, USA.
| | - Bianca Weinstock-Guttman
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St, Buffalo, NY, 14203, USA
- Jacobs Multiple Sclerosis Center for Treatment and Research, Buffalo, USA
| | - Sangharsha Thapa
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St, Buffalo, NY, 14203, USA
- Jacobs Multiple Sclerosis Center for Treatment and Research, Buffalo, USA
| | - Omid Mirmosayyeb
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St, Buffalo, NY, 14203, USA
- Jacobs Multiple Sclerosis Center for Treatment and Research, Buffalo, USA
| | - Samreen Awan
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St, Buffalo, NY, 14203, USA
- Jacobs Multiple Sclerosis Center for Treatment and Research, Buffalo, USA
| | - Svetlana Eckert
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St, Buffalo, NY, 14203, USA
- Jacobs Multiple Sclerosis Center for Treatment and Research, Buffalo, USA
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8
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Giaccari LG, Mastria D, Barbieri R, De Maglio R, Madaro F, Paiano G, Pace MC, Sansone P, Pulito G, Mascia L. Bickerstaff encephalitis in childhood: a review of 74 cases in the literature from 1951 to today. Front Neurol 2024; 15:1387505. [PMID: 38533411 PMCID: PMC10963475 DOI: 10.3389/fneur.2024.1387505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
Bickerstaff brainstem encephalitis (BBE) is a rare autoimmune disease characterized by the subacute onset of bilateral external ophthalmoplegia, ataxia, and decreased level of consciousness. BBE is part of a group of rare autoimmune diseases in children that can affect the nervous system at any level. The onset of neurological deficits is often sudden and nonspecific. The diagnosis is based on clinical findings and abnormal findings on cerebrospinal fluid (CSF), electroencephalography (EEG), electromyography (EMG), and magnetic resonance imaging (MRI). BBE is associated with the presence of the antiganglioside antibody, anti-GQ1b and anti-GM1. Intravenous immunoglobulin (IVIg) and plasma exchange are often used as treatments for these patients. We conducted a review on clinical presentation, diagnosis, treatment and outcome of reported cases of BBE. 74 cases are reported in the literature from the first cases described in 1951 to today. The prevalence is unknown while the incidence is higher in males. In 50% of cases, BBE occurs following respiratory or gastrointestinal tract infections. The most frequent initial symptoms were consciousness disturbance, headache, vomiting, diplopia, gait disturbance, dysarthria and fever. During illness course, almost all the patients developed consciousness disturbance, external ophthalmoplegia, and ataxia. Lumbar puncture showed pleocytosis or cytoalbuminological dissociation. Abnormal EEG and MRI studies revealed abnormalities in most cases. Anti-GQ1b antibodies were detected in more than half of the patients; anti-GM1 antibodies were detected in almost 40% of patients. Treatment guidelines are missing. In our analysis, steroids and IVIg were administered alone or in combination; as last option, plasmapheresis was used. BBE has a good prognosis and recovery in childhood is faster than in adulthood; 70% of patients reported no sequelae in our analysis. Future studies need to investigate pathogenesis and possible triggers, and therapeutic possibilities.
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Affiliation(s)
| | - Donatella Mastria
- Department of Anesthesia and Intensive Care, “Vito Fazzi” Hospital, Lecce, Italy
| | - Rosella Barbieri
- Department of Anesthesia and Intensive Care, “Vito Fazzi” Hospital, Lecce, Italy
| | - Rossella De Maglio
- Department of Anesthesia and Intensive Care, “Vito Fazzi” Hospital, Lecce, Italy
| | - Francesca Madaro
- Department of Anesthesia and Intensive Care, “Vito Fazzi” Hospital, Lecce, Italy
| | - Gianfranco Paiano
- Department of Anesthesia and Intensive Care, “Vito Fazzi” Hospital, Lecce, Italy
| | - Maria Caterina Pace
- Department of Women, Child, General and Specialist Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Pasquale Sansone
- Department of Women, Child, General and Specialist Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Giuseppe Pulito
- Department of Anesthesia and Intensive Care, “Vito Fazzi” Hospital, Lecce, Italy
| | - Luciana Mascia
- Department of Experimental Medicine, University of Salento, Lecce, Italy
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9
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Donaldson L, Jeeva-Patel T, Mandell D, Margolin E. Enhancement of Subarachnoid Oculomotor Nerves in Bickerstaff Brainstem Encephalitis. Can J Neurol Sci 2024; 51:323-324. [PMID: 36537000 DOI: 10.1017/cjn.2022.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Laura Donaldson
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Trishal Jeeva-Patel
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Mandell
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Edward Margolin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
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10
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Bellanti R, Keddie S, Lunn MP, Rinaldi S. Ultrasensitive assay technology and fluid biomarkers for the evaluation of peripheral nerve disease. J Neurol Neurosurg Psychiatry 2024; 95:114-124. [PMID: 37821222 DOI: 10.1136/jnnp-2023-332031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/22/2023] [Indexed: 10/13/2023]
Abstract
The field of biomarker discovery is rapidly expanding. The introduction of ultrasensitive immunoassays and the growing precision of genetic technologies are poised to revolutionise the assessment and monitoring of many diseases. Given the difficulties in imaging and tissue diagnosis, there is mounting interest in serum and cerebrospinal fluid biomarkers of peripheral neuropathy. Realised and potential fluid biomarkers of peripheral nerve disease include neuronal biomarkers of axonal degeneration, glial biomarkers for peripheral demyelinating disorders, immunopathogenic biomarkers (such as the presence and titre of antibodies or the levels of cytokines) and genetic biomarkers. Several are already starting to inform clinical practice, whereas others remain under evaluation as potential indicators of disease activity and treatment response. As more biomarkers become available for clinical use, it has become increasingly difficult for clinicians and researchers to keep up-to-date with the most recent discovery and interpretation. In this review, we aim to inform practising neurologists, neuroscientists and other clinicians about recent advances in fluid biomarker technology, with a focus on single molecule arrays (Simoa), chemiluminescent enzyme immunoassays (CLEIA), electrochemiluminescence (ECL), proximity extension assays (PEA), and microfluidic technology. We discuss established and emerging fluid biomarkers of peripheral neuropathy, their clinical applications, limitations and potential future developments.
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Affiliation(s)
- Roberto Bellanti
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
| | - Stephen Keddie
- Department of Neuromuscular Diseases, The Royal London Hospital, London, UK
| | - Michael P Lunn
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
- Department of Neuroinflammation, National Hospital for Neurology and Neurosurgery, London, UK
| | - Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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11
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García de Andoin Sojo C, Gómez Muga JJ, Aza Martínez I, Antón Méndez L, Fornell Pérez R. Inflammatory lesions of the brainstem: Keys for the diagnosis by MRI. RADIOLOGIA 2024; 66:32-46. [PMID: 38365353 DOI: 10.1016/j.rxeng.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/15/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVE To describe the magnetic resonance imaging (MRI) findings for the most common inflammatory and immune-mediated diseases that involve the brainstem. CONCLUSION Inflammatory lesions involving the brainstem are associated with a wide range of autoimmune, infectious, and paraneoplastic syndromes, making the differential diagnosis complex. Being familiar with these entities, their clinical characteristics, and their manifestations on MRI, especially the number of lesions, their shape and extension, and their appearance in different sequences, is useful for orienting the radiological diagnosis.
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Affiliation(s)
| | - J J Gómez Muga
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Spain
| | - I Aza Martínez
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Spain
| | - L Antón Méndez
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Spain
| | - R Fornell Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Spain
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12
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Asbeutah S, Alhashime K, Alhamer M. A Case Report and Literature Review on Positivity for Multiple Antibodies: Autoimmune Encephalitis in Focus. Cureus 2023; 15:e50393. [PMID: 38213350 PMCID: PMC10783615 DOI: 10.7759/cureus.50393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Autoimmune encephalitis (AE) is a group of neuropsychiatric disorders caused by antibodies that target the neuronal surface, synaptic, or intracellular antigens, impairing brain function. Although AE can affect people of different age groups, the occurrence of AE within specific age brackets depends on the specific type of AE and the antibodies produced. While AE is frequently considered a paraneoplastic syndrome linked to cancer, it is essential to acknowledge that the intensity of this association can vary depending on the specific antibody, leading to diverse relationships with paraneoplastic syndromes. Numerous cases have been recorded where AE manifests without an underlying malignancy. The diagnostic criteria for AE are characterized by a subacute deterioration of cognition, altered mental status, or psychiatric symptoms. Immunotherapy is recommended as a treatment for the condition, and the prognosis varies depending on the subtype. In this case, we present the case of an elderly woman who showed acute mental status changes, psychiatric symptoms, EEG alterations, and positive antibody results in both serum and CSF. Our case breaks new ground as the first documented instance of a female with positive serum anti-LGI 1, anti-AMPAR2, anti-Ri, and anti-CENP-A/B antibodies.
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Affiliation(s)
| | | | - Maryam Alhamer
- Internal Medicine, Kuwait Board of Internal Medicine, Kuwait City, KWT
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13
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Habib AA, Waheed W. Guillain-Barré Syndrome. Continuum (Minneap Minn) 2023; 29:1327-1356. [PMID: 37851033 DOI: 10.1212/con.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article summarizes the clinical features, diagnostic criteria, differential diagnosis, pathogenesis, and prognosis of Guillain-Barré syndrome (GBS), with insights into the current and future diagnostic and therapeutic interventions for this neuromuscular syndrome. LATEST DEVELOPMENTS GBS is an acute, inflammatory, immune-mediated polyradiculoneuropathy that encompasses many clinical variants and divergent pathogenic mechanisms that lead to axonal, demyelinating, or mixed findings on electrodiagnostic studies. The type of antecedent infection, the development of pathogenic cross-reactive antibodies via molecular mimicry, and the location of the target gangliosides affect the subtype and severity of the illness. The data from the International GBS Outcome Study have highlighted regional variances, provided new and internationally validated prognosis tools that are beneficial for counseling, and introduced a platform for discussion of GBS-related open questions. New research has been undertaken, including research on novel diagnostic and therapeutic biomarkers, which may lead to new therapies. ESSENTIAL POINTS GBS is among the most frequent life-threatening neuromuscular emergencies in the world. At least 20% of patients with GBS have a poor prognosis and significant residual deficits despite receiving available treatments. Research is ongoing to further understand the pathogenesis of the disorder, find new biomarkers, and develop more effective and specific treatments.
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14
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Liu CH, Chiu LC, Lee CC, Chan TM. Case Report: High-dose steroid and IVIG successful treatment in a case of COVID-19-associated autoimmune encephalitis: a literature review. Front Immunol 2023; 14:1240089. [PMID: 37809102 PMCID: PMC10557068 DOI: 10.3389/fimmu.2023.1240089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Autoimmune encephalitis is a rare but critical complication of COVID-19. The management of COVID-19-associated autoimmune encephalitis includes the use of steroids, intravenous immunoglobulin (IVIG), plasmapheresis, and monoclonal antibody therapy. This study presented a patient with critical COVID-19 autoimmune encephalitis who rapidly recovered after the initiation of corticosteroids and IVIG therapy. This study reviewed the current literature on the pathophysiological mechanisms, diagnosis, and management of COVID-19-associated autoimmune encephalitis.
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Affiliation(s)
- Chi-Hung Liu
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Li-Chung Chiu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Chun Lee
- Department of Medical Education, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Tien-Ming Chan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, and Chang Gung University, Taoyuan, Taiwan
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15
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Zhang L, Ma L, Zhou L, Sun L, Han C, Fang Q. Miller-Fisher syndrome with positive anti-GD1b and anti-GM1 antibodies combined with multiple autoimmune antibodies: A case report. Medicine (Baltimore) 2023; 102:e34969. [PMID: 37653808 PMCID: PMC10470702 DOI: 10.1097/md.0000000000034969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
RATIONALE Anti-ganglioside antibodies (AGA) play an essential role in the development of Miller-Fisher syndrome (MFS). The positive rate of ganglioside antibodies was exceptionally high in MFS, especially anti-GQ1b antibodies. However, the presence of other ganglioside antibodies does not exclude MFS. PATIENT CONCERNS We present a 48-year-old male patient who suddenly developed dizziness, visual rotation, nausea, and vomiting accompanied by unsteady gait and diplopia for 3 days before presentation to our clinic. DIAGNOSES On physical examination, the patient's right eye could not fully move to the right side and horizontal nystagmus was found. Coordination was also impaired in the upper and lower extremities with dysmetria and dysdiadochokinesia. The electromyography and cerebrospinal fluid examination results were normal. The serum anti-GQlb antibody test results were negative. However, serum anti-GD1b IgM and anti-GM1 IgM antibodies were positive. Meanwhile, the anti-thyroid peroxidase antibody was >600.00 IU/mL (0.00-34.00), and the anti-SS-A/Ro52 antibody was positive. He was diagnosed with MFS. INTERVENTIONS The patient received IVIg treatment for 5 days (0.4 g/kg/day) from day 2 to day 6 of hospitalization. On the 7th day of admission, the patient was administered intravenous methylprednisolone (500 mg/day), which was gradually reduced. OUTCOMES The patient's symptoms improved after treatment with immunoglobulins and hormones. LESSONS We report a case of MFS with positive anti-GD1b and anti-GM1 antibodies combined with multiple autoimmune antibodies. Positive ganglioside antibodies may be used as supporting evidence for the diagnosis; however, the diagnosis of MFS is more dependent on clinical symptoms.
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Affiliation(s)
- Limei Zhang
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Linqing Ma
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Lihua Zhou
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Lu Sun
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Chunru Han
- Department of Neurology, the People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Qi Fang
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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16
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Abide Z, Sif Nasr K, Kaddouri S, Edderai M, Elfenni J, Salaheddine T. Bickerstaff brainstem encephalitis: A case report. Radiol Case Rep 2023; 18:2704-2706. [PMID: 37304311 PMCID: PMC10250568 DOI: 10.1016/j.radcr.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 06/13/2023] Open
Abstract
Bickerstaff brainstem encephalitis (BBE) is a rare inflammatory, demyelinating disease that generally has a good prognosis. It's characterized by an acute dysfunction of brainstem occurring few days after an infection. We report the case of an 11-year-old male child with a history of cold, presented with ataxia in whom a Bickerstaff encephalitis was attested through brain MRI and who has fully recovered after treatment. The main symptoms are ataxia, ophthalmoplegia, and altered consciousness. CSF analysis and serum antiganglioside antibodies are also very suggestive of the diagnosis that can be suspected clinically and confirmed on brain MRI. The interest of this observation lies in its rarity and on the rapid and spectacular clinical improvement under treatment.
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17
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Atypical Imaging Findings in Anti-GQ1b Brainstem Encephalitis. Can J Neurol Sci 2023; 50:292-293. [PMID: 35581189 DOI: 10.1017/cjn.2022.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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García de Andoin Sojo C, Gómez Muga J, Aza Martínez I, Antón Méndez L, Fornell Pérez R. Lesiones inflamatorias del troncoencéfalo: claves diagnósticas en RM. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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19
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Leboyan A, Esselin F, Bascou AL, Duflos C, Ion I, Charif M, Castelnovo G, Carra-Dalliere C, Ayrignac X, Kerschen P, Chbicheb M, Nguyen L, Maria ATJ, Guilpain P, Carriere M, de Champfleur NM, Vincent T, Jentzer A, Labauge P, Devaux JJ, Taieb G. Immune-mediated diseases involving central and peripheral nervous systems. Eur J Neurol 2023; 30:490-500. [PMID: 36366904 DOI: 10.1111/ene.15628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 10/03/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE In addition to combined central and peripheral demyelination, other immune diseases could involve both the central nervous system (CNS) and peripheral nervous system (PNS). METHODS To identify immune-mediated diseases responsible for symptomatic combined central/peripheral nervous system involvement (ICCPs), we conducted a multicentric retrospective study and assessed clinical, electrophysiological, and radiological features of patients fulfilling our ICCP criteria. RESULTS Thirty patients (20 males) were included and followed during a median of 79.5 months (interquartile range [IQR] = 43-145). The median age at onset was 51.5 years (IQR = 39-58). Patients were assigned to one of four groups: (i) monophasic disease with concomitant CNS/PNS involvement including anti-GQ1b syndrome (acute polyradiculoneuropathy + rhombencephalitis, n = 2), checkpoint inhibitor-related toxicities (acute polyradiculoneuropathy + encephalitis, n = 3), and anti-glial fibrillary acidic protein astrocytopathy (subacute polyradiculoneuropathy and meningoencephalomyelitis with linear gadolinium enhancements, n = 2); (ii) chronic course with concomitant CNS/PNS involvement including paraneoplastic syndromes (ganglionopathy/peripheral hyperexcitability + limbic encephalitis, n = 4); (iii) chronic course with sequential CNS/PNS involvement including POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome (polyradiculoneuropathy + strokes, n = 2), histiocytosis (polyradiculoneuropathy + lepto-/pachymeningitis, n = 1), and systemic vasculitis (multineuropathy + CNS vasculitis/pachymeningitis, n = 2); and (iv) chronic course with concomitant or sequential CNS/PNS involvement including combined central and peripheral demyelination (polyradiculoneuropathy + CNS demyelinating lesions, n = 10) and connective tissue diseases (ganglionopathy/radiculopathy/multineuropathy + limbic encephalitis/transverse myelitis/stroke, n = 4). CONCLUSIONS We diagnosed nine ICCPs. The timing of central and peripheral manifestations and the disease course help determine the underlying immune disease. When antibody against neuroglial antigen is identified, CNS and PNS involvement is systematically concomitant, suggesting a common CNS/PNS antigen and a simultaneous disruption of blood-nerve and blood-brain barriers.
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Affiliation(s)
- Aurelie Leboyan
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
| | - Florence Esselin
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
| | - Anne-Laure Bascou
- Clinical Research and Epidemiology Unit, University Hospital Center, University of Montpellier, Montpellier, France
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, University Hospital Center, University of Montpellier, Montpellier, France
| | - Ioana Ion
- Department of Neurology, Caremeau University Hospital Center, Nîmes, France
| | - Mahmoud Charif
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
| | | | | | - Xavier Ayrignac
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
| | - Philippe Kerschen
- Department of Neurology, Luxembourg Hospital Center, Luxembourg City, Luxembourg
| | - Mohamed Chbicheb
- Department of Neurology, Narbonne Hospital Center, Narbonne, France
| | - Ludovic Nguyen
- Department of Neurology, Perpignan Hospital Center, Perpignan, France
| | - Alexandre T J Maria
- Department of Internal Medicine, Saint Eloi University Hospital Center, Montpellier, France
| | - Philippe Guilpain
- Department of Internal Medicine, Saint Eloi University Hospital Center, Montpellier, France
| | - Mathilde Carriere
- Department of Neuroradiology, Gui de Chauliac University Hospital Center, Montpellier, France
| | | | - Thierry Vincent
- Department of Immunology, Saint Eloi University Hospital Center, Montpellier, France
| | - Alexandre Jentzer
- Department of Immunology, Saint Eloi University Hospital Center, Montpellier, France
| | - Pierre Labauge
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
| | - Jérôme J Devaux
- Institute of Functional Genomics, National Center for Scientific Research UMR5203, Montpellier, France
| | - Guillaume Taieb
- Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France
- Institute of Functional Genomics, National Center for Scientific Research UMR5203, Montpellier, France
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20
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Fujii K, Shiohama T, Uchida T, Ikehara H, Fukuhara T, Sawada D, Aoyama H, Uchikawa H, Yoshii S, Arahata Y, Shimojo N, Misawa S, Kuwabara S. Nationwide survey of childhood Guillain-Barré syndrome, Fisher syndrome, and Bickerstaff brainstem encephalitis in Japan. Brain Dev 2023; 45:16-25. [PMID: 36511273 DOI: 10.1016/j.braindev.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/05/2022] [Accepted: 09/18/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Guillain-Barré syndrome (GBS), Fisher syndrome (FS), and Bickerstaff brainstem encephalitis (BBE) are immune-mediated neuropathies presenting with symptoms such as weakness, ophthalmoplegia, ataxia, and consciousness disturbances. Although the epidemiology of GBS and BBE in patients of all ages has been reported, childhood data have not been well-investigated. We aimed to determine the clinical features, therapeutics, and prognoses of childhood GBS, FS, and BBE in Japan. METHODS We sent questionnaires to 1068 pediatric neurologists in Japan from 2014 to 2016 to determine the number of children less than 15 years old with GBS, FS, or BBE and their age and sex. We subsequently performed a secondary survey to investigate the clinical features, laboratory data, treatment, and prognosis. RESULTS Five-hundred thirty-eight pediatric neurology specialists (50.4%) responded to the first survey. The total number of children with GBS, FS, and BBE in Japan from 2014 to 2016 were 87, 10, and 6, respectively. GBS was classified as acute inflammatory demyelinating neuropathy (35.6%), acute motor axonal neuropathy (20.7%), or acute motor-sensory axonal neuropathy (10.3%), with a male-to-female ratio of 1.29:1.0 and a wide distribution of onset ages. The disease severities of GBS, FS, and BBE were variable, but all children could walk within one year. CONCLUSION The prognoses of childhood GBS, FS, and BBE were generally favorable, as long as the patient was promptly treated with either intravenous immunoglobulin or plasma exchange.
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Affiliation(s)
- Katsunori Fujii
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Pediatrics, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan.
| | - Tadashi Shiohama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Uchida
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Ikehara
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoyuki Fukuhara
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Sawada
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiromi Aoyama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideki Uchikawa
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shoko Yoshii
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yukie Arahata
- Department of Pediatrics, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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21
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Gaig C, Graus F. Motor symptoms in nonparaneoplastic CNS disorders associated with neural antibodies. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:277-294. [PMID: 37620074 DOI: 10.1016/b978-0-323-98817-9.00004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Motor symptoms are common, and sometimes predominant, in almost all nonparaneoplastic CNS disorders associated with neural antibodies. These CNS disorders can be classified into five groups: (1) Autoimmune encephalitis with antibodies against synaptic receptors, (2) cerebellar ataxias associated with neuronal antibodies that mostly target intracellular antigens. (3) Stiff-person syndrome and progressive encephalomyelitis with rigidity and myoclonus which have antibodies against glutamic acid decarboxylase and glycine receptor, respectively. Both diseases have in common the presence of predominant muscle stiffness and rigidity. (4) Three diseases associated with glial antibodies. Two present motor symptoms mainly due to the involvement of the spinal cord: neuromyelitis optica spectrum disorders with aquaporin-4 antibodies and myelin oligodendrocyte glycoprotein antibody-associated disease. The third disorder is the meningoencephalitis associated with glial fibrillar acidic protein antibodies which frequently also presents a myelopathy. (5) Two antibody-related diseases which are characterized by prominent sleep dysfunction: anti-IgLON5 disease, a disorder that frequently presents a variety of movement disorders, and Morvan syndrome associated with contactin-associated protein-like 2 antibodies and clinical manifestations of peripheral nerve hyperexcitability. In this chapter, we describe the main clinical features of these five groups with particular emphasis on the presence, frequency, and types of motor symptoms.
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Affiliation(s)
- Carles Gaig
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Francesc Graus
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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22
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Bhatia SS, Canepa C, Notarianni A. Bickerstaff’s brainstem encephalitis mimicking herpetic encephalomyelitis in a liver transplant patient with anti-GQ1b antibodies. BMJ Case Rep 2022; 15:15/12/e251784. [DOI: 10.1136/bcr-2022-251784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A woman in her late 70s with a history of liver transplant presented with ophthalmoplegia, ataxia, areflexia, positive Babinski’s sign and reduced consciousness. This followed an antecedent illness in the form of a herpes zoster infection. MRI of the brain/spinal cord, cerebrospinal fluid analysis with viral PCR and routine blood tests were normal, and tacrolimus neurotoxicity was ruled out. Serum anti-GQ1b antibodies were positive. A diagnosis of Bickerstaff’s brainstem encephalitis was made, forming part of the continuum that involves Miller-Fisher syndrome, entitled the ‘anti-GQ1b syndrome’. Complete recovery ensued without intravenous immunoglobulins or plasma exchange. The role of monitoring anti-ganglioside pattern change to predict or confirm disease recurrence and disease severity is further discussed.
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23
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Morooka M, Hiraga A, Tanaka K, Yoshizaki S, Koide K, Kuwabara S. Two Cases of Encephalitis without Anti-N-methyl-D-aspartate Receptor Antibody Successfully Treated with Ovarian Teratoma Resection and Immunotherapy. Intern Med 2022. [PMID: 36328575 DOI: 10.2169/internalmedicine.0447-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder sometimes accompanied by ovarian teratoma. However, the concept of encephalitis without anti-NMDAR antibodies successfully treated with ovarian teratoma resection and immunotherapy has not been established. We herein report two such cases. Case 1 exhibited delayed magnetic resonance imaging abnormalities in the thalamus and basal ganglia, despite clinical improvement. Case 2 presented with brainstem encephalitis similar to Bickerstaff's encephalitis. Although both patients tested negative for anti-NMDAR antibodies, the recovery of the neurological function and good prognosis following tumor resection with immunotherapy indicated a close association between these diseases and ovarian teratoma.
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Affiliation(s)
- Marie Morooka
- Department of Neurology, Chiba Rosai Hospital, Japan
| | | | - Keiko Tanaka
- Brain Research Institute, Niigata University, Japan
| | | | - Kyosuke Koide
- Department of Neurology, Chiba Rosai Hospital, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
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24
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Etiology matters for neuroprognostication: A multimodal electrophysiological investigation in a case of Bickerstaff's brainstem encephalitis. Neurophysiol Clin 2022; 52:398-403. [DOI: 10.1016/j.neucli.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022] Open
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25
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Stezin A, Pal PK. Treatable Ataxias: How to Find the Needle in the Haystack? J Mov Disord 2022; 15:206-226. [PMID: 36065614 DOI: 10.14802/jmd.22069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
Treatable ataxias are a group of ataxic disorders with specific treatments. These disorders include genetic and metabolic disorders, immune-mediated ataxic disorders, and ataxic disorders associated with infectious and parainfectious etiology, vascular causes, toxins and chemicals, and endocrinopathies. This review provides a comprehensive overview of different treatable ataxias. The major metabolic and genetic treatable ataxic disorders include ataxia with vitamin E deficiency, abetalipoproteinemia, cerebrotendinous xanthomatosis, Niemann-Pick disease type C, autosomal recessive cerebellar ataxia due to coenzyme Q10 deficiency, glucose transporter type 1 deficiency, and episodic ataxia type 2. The treatment of these disorders includes the replacement of deficient cofactors and vitamins, dietary modifications, and other specific treatments. Treatable ataxias with immune-mediated etiologies include gluten ataxia, anti-glutamic acid decarboxylase antibody-associated ataxia, steroid-responsive encephalopathy associated with autoimmune thyroiditis, Miller-Fisher syndrome, multiple sclerosis, and paraneoplastic cerebellar degeneration. Although dietary modification with a gluten-free diet is adequate in gluten ataxia, other autoimmune ataxias are managed by short-course steroids, plasma exchange, or immunomodulation. For autoimmune ataxias secondary to malignancy, treatment of tumor can reduce ataxic symptoms. Chronic alcohol consumption, antiepileptics, anticancer drugs, exposure to insecticides, heavy metals, and recreational drugs are potentially avoidable and treatable causes of ataxia. Infective and parainfectious causes of cerebellar ataxias include acute cerebellitis, postinfectious ataxia, Whipple's disease, meningoencephalitis, and progressive multifocal leukoencephalopathy. These disorders are treated with steroids and antibiotics. Recognizing treatable disorders is of paramount importance when dealing with ataxias given that early treatment can prevent permanent neurological sequelae.
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Affiliation(s)
- Albert Stezin
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.,Centre for Brain Research, Indian Institute of Science, Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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26
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Shimada T, Sano M, Tsunemi T, Hattori N. Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion Coincidents with Bickerstaff Brainstem Encephalitis. Neurol India 2022; 70:1746-1747. [PMID: 36076717 DOI: 10.4103/0028-3886.355132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tomoyo Shimada
- Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Mariko Sano
- Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Taiji Tsunemi
- Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan
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27
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Thomas NJ, Shekarchian S, Bock MA, Holmes BB, Geha RM, Shah MP. A striking dichotomy. J Hosp Med 2022; 17:485-488. [PMID: 35535948 PMCID: PMC9197992 DOI: 10.1002/jhm.2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/21/2021] [Accepted: 01/14/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Nicholas J Thomas
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sharmin Shekarchian
- Department of Medicine, Palo Alto Veterans Affairs Medical Center, Palo Alto, California, USA
| | - Meredith A Bock
- Weill UCSF Department of Neurology, UCSF Medical Center, San Francisco, California, USA
| | - Brandon B Holmes
- Weill UCSF Department of Neurology, UCSF Medical Center, San Francisco, California, USA
| | - Rabih M Geha
- Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Maulik P Shah
- Weill UCSF Department of Neurology, UCSF Medical Center, San Francisco, California, USA
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28
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Wu X, Wang Y, Xi ZQ. Clinical and antibodies analysis of anti-GQ1b antibody syndrome: a case series of 15 patients. Acta Neurol Belg 2022:10.1007/s13760-022-01940-1. [PMID: 35399126 PMCID: PMC8995142 DOI: 10.1007/s13760-022-01940-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/21/2022] [Indexed: 12/01/2022]
Abstract
Objectives To investigate the clinical manifestations, immunity, laboratory test, treatment and prognosis of patients with anti-GQ1b antibody syndrome in Chongqing, China. Methods We reviewed 15 patients with positive anti-ganglioside antibodies in the First Affiliated Hospital of Chongqing Medical University from 2016 to 2019. Results Fifteen patients were included in the study (mean age, 54.4 years; age range, 27 to 80 years; 9 men (60%)). Ten patients presented with a history of preinfection, including flu-like syndrome (n = 6, 60%), upper respiratory tract infection (URTI) (n = 3, 30%), and digestive tract infection (GI) (n = 1, 10%). The most common manifestation was ophthalmoplegia (n = 13, 86.67%), followed by weakness (n = 12, 80%), ataxia (n = 11, 73.3%), paresthesia (n = 8, 53.33%) and hypersomnolence (n = 5, 33.33%). All 15 patients underwent antibody testing. Eight patients (53.33%, 7 men (87.5%)) of whom only have positive immunoglobulin G (IgG) against anti-GQ1b antibody while seven (46.67%, 2 men (28.57%)) were positive for multiple anti-ganglioside antibodies apart from anti-GQ1b antibodies. Nine patients (60%) received intravenous immunoglobulin (IVIG) therapy, four (26.67%) received plasma exchange (PE) and two (13.33%) received steroid therapy. Three patients were lost to follow-up at 6 months, 1 patient (6.67%) had persistent back numbness, and the other 11 patients (73.33%) had fully recovered. Conclusion The clinical subtype of anti-GQ1b antibody syndrome correlates with the type of anti-ganglioside antibody. Patients who test positive for only anti-GQ1b antibody are more likely to be men. Most patients exhibit a unidirectional course with a good prognosis, but anti-GQ1b antibody syndrome is also associated with a risk of recurrence.
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Affiliation(s)
- Xiaohui Wu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 1 You Yi Road, Chongqing, 400016, China
| | - Yuzhu Wang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 1 You Yi Road, Chongqing, 400016, China
| | - Zhi-Qin Xi
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 1 You Yi Road, Chongqing, 400016, China.
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[Unusual forms of inflammatory diseases of the central nervous system]. Radiologe 2022; 62:302-307. [PMID: 35301573 DOI: 10.1007/s00117-022-00983-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND White matter lesions of the central nervous system (CNS) are frequently encountered on magnetic resonance imaging (MRI) exams. If the morphologic findings, clinical symptoms and laboratory results are not typical for one of the more common inflammatory CNS diseases, the diagnosis may become challenging, which also means that interesting and sometime emotional discussions may arise. OBJECTIVE While frequent causes of inflammatory CNS diseases were already discussed in a previous article, we now focus on more seldom forms and place attention on morphologic characteristics which may help to find the correct diagnosis.
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Ban H, Miura K, Hattori M. Bickerstaff brainstem encephalitis treated using selective plasma exchange owing to anaphylaxis attributed to fresh frozen plasma: A case report. Ther Apher Dial 2022; 26:548-549. [PMID: 35247234 DOI: 10.1111/1744-9987.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Hideki Ban
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital.,Department of Pediatric Nephrology, Tokyo Women's Medical University
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women's Medical University
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University
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Lestayo O'Farrill Z, González-Quevedo A, Gutierrez-Gil J, Hernández-Cáceres JL, Sistach-Vega V. Proposal for the functional assessment of acute inflammatory neuropathy (FAAIN) in Guillain-Barré syndrome. Neurol Res 2022; 44:534-543. [PMID: 35168471 DOI: 10.1080/01616412.2021.2024725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Guillain Barré syndrome (GBS) functional assessment is necessary in clinical practice, research and clinical trials. Existing instruments are not sensitive to change and are not applicable to the current GBS clinical spectrum. OBJECTIVE To construct a functional assessment for acute inflammatory neuropathies (FAAIN-GBS), inclusive for current GBS spectrum that assesses extension and intensity separately. METHODS FAAIN-GBS subscales were constructed. Its structure and interpretation were defined. It was validated using data from medical record of 167 GBS patients admitted to the Institute of Neurology and Neurosurgery. Cronbach α was used for items reduction and reliability analysis. Bartlett sphericity test was performed. Exploratory factor analysis (EFA) of the main components, with varimax rotation, was applied to evaluate dimensionality and content validity. Hughes scale was used as gold standard for criterion validity. Sensitivity, specificity and area under the receiver operating characteristic curves (AUROC), were calculated. Construct validity was assessed by confirmatory factor analysis (CFA). RESULTS FAAIN-GBS is made up of two subscales (extension and intensity). The final score is obtained by averaging both dimensions. Internal consistency was acceptable (Cronbach 0.745). EFA showed three dimensions: intensity, spinal extension and cranial extension. Spearman correlation between FAAIN-GBS and Hughes scale was 0.463. Sensitivity (0.714) and specificity (0.986) values showed the good behavior of the scale; AUROC was 0.93. CONCLUSION FAAIN-GBS was constructed and a first step of validation was made, showing good internal consistency and validity. New prospective studies with large populations will be necessary to perfect this instrument that could be useful in neurological practice.
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Affiliation(s)
- Zurina Lestayo O'Farrill
- Neuromuscular Section, Neurology Department, National Institute of Neurology and Neurosurgery, La Habana, Cuba
| | - Alina González-Quevedo
- Neuromuscular Section, Neurology Department, National Institute of Neurology and Neurosurgery, La Habana, Cuba
| | - Joel Gutierrez-Gil
- Neuromuscular Section, Neurology Department, National Institute of Neurology and Neurosurgery, La Habana, Cuba
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Imam I, Sarrigiannis PG, Shivane AG. Bickerstaff brainstem encephalitis: clinical, neurophysiological, laboratory and postmortem findings of a case presenting as encephalomyelitis. BMJ Case Rep 2022; 15:e245588. [PMID: 35110279 PMCID: PMC8811546 DOI: 10.1136/bcr-2021-245588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/04/2022] Open
Abstract
Our patient was admitted to hospital with a 1-week history of an upper respiratory tract infection and a rapidly progressive encephalopathy dominated by brainstem features and widespread areflexia. Her antiganglioside antibodies and electroencephalography were consistent with Bickerstaff brainstem encephalitis (BBE), and her postmortem examination revealed a predominantly florid brainstem encephalitis and myelitis. Her sputum and throat swabs isolated Haemophilus influenzae and Fusobacterium, respectively, the former being the most probable trigger of BBE. Our patient's death, despite the otherwise good prognosis of the disorder, may reflect the severity of the pathological changes at postmortem or the association of comorbid disorders such as sepsis-associated encephalopathy. Her poor outcome may also be an indication to treat rapidly progressive cases of BBE with more than one immune modulating drug.
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Affiliation(s)
- Ibrahim Imam
- Neurology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | | | - Aditya G Shivane
- Department of Cellular and Anatomical Pathology, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Kimura M, Hashiguchi S, Tanaka K, Hagiwara M, Takahashi K, Miyaji Y, Joki H, Doi H, Koga M, Takeuchi H, Tanaka F. Case Report: Takotsubo Cardiomyopathy in Bickerstaff Brainstem Encephalitis Triggered by COVID-19. Front Neurol 2022; 12:822247. [PMID: 35002947 PMCID: PMC8741194 DOI: 10.3389/fneur.2021.822247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/08/2021] [Indexed: 12/28/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy triggered by critical illness including severe neurological disorders. However, an association between TCM and Bickerstaff brainstem encephalitis (BBE) has rarely been described. During the current coronavirus disease 2019 (COVID-19) pandemic, growing evidence indicates that COVID-19 often leads to various neurological disorders, but there are few reports of an association between COVID-19 and BBE. Here we report a case of TCM associated with BBE triggered by COVID-19, which subsided with immunotherapy for BBE. Both transthoracic echocardiography and electrocardiography led to early and accurate diagnosis of TCM. Sustained hemodynamic instability due to TCM was immediately lessened with immunotherapy whereas additional plasmapheresis and immunotherapy were required to treat BBE. This case indicates that BBE might follow COVID-19 and TCM should be considered when hemodynamic status remains unstable in a patient with BBE.
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Affiliation(s)
- Mizuki Kimura
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shunta Hashiguchi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kenichi Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Manato Hagiwara
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Keita Takahashi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yosuke Miyaji
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideto Joki
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Doi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Michiaki Koga
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hideyuki Takeuchi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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[Pathophysiological and diagnostic aspects of Guillain-Barré syndrome]. Rev Med Interne 2022; 43:419-428. [PMID: 34998626 DOI: 10.1016/j.revmed.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022]
Abstract
Guillain-Barré syndrome (GBS) is the most common cause of acute neuropathy. It usually onset with a rapidly progressive ascending bilateral weakness with sensory disturbances, and patients may require intensive treatment and close monitoring as about 30% have a respiratory muscle weakness and about 10% have autonomic dysfunction. The diagnosis of GBS is based on clinical history and examination. Complementary examinations are performed to rule out a differential diagnosis and to secondarily confirm the diagnosis. GBS is usually preceded by an infectious event in ≈ 2/3 of cases. Infection leads to an immune response directed against carbohydrate antigens located on the infectious agent and the formation of anti-ganglioside antibodies. By molecular mimicry, these antibodies can target structurally similar carbohydrates found on host's nerves. Their binding results in nerve conduction failure or/and demyelination which can lead to axonal loss. Some anti-ganglioside antibodies are associated with particular variants of GBS: the Miller-Fisher syndrome, facial diplegia and paresthesias, the pharyngo-cervico-brachial variant, the paraparetic variant, and the Bickerstaff brainstem encephalitis. Their semiological differences might be explained by a distinct expression of gangliosides among nerves. The aim of this review is to present pathophysiological aspects and the diagnostic approach of GBS and its variants.
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35
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El-Abassi RN, Soliman M, Levy MH, England JD. Treatment and Management of Autoimmune Neuropathies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bagaria AK, Vyas A, Mathur V, Ranawat CS, Singh M. Bickerstaff Brainstem Encephalitis with Isolated Acute Bilateral Ophthalmoplegia: An Unusual Presentation. Ann Indian Acad Neurol 2021; 24:624-626. [PMID: 34728976 PMCID: PMC8513979 DOI: 10.4103/aian.aian_823_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/13/2020] [Accepted: 08/23/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Arvind Vyas
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | - Vaibhav Mathur
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | | | - Mridula Singh
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
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37
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Romano N, Federici M, Castaldi A. Imaging Presentation of Bickerstaff Brainstem Encephalitis. Neurohospitalist 2021; 11:370-372. [PMID: 34567402 DOI: 10.1177/1941874421993671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nicola Romano
- Department of Diagnostic and Interventional Neuroradiology, E.O. Ospedali Galliera, Genoa, Italy
| | - Margherita Federici
- Department of Diagnostic and Interventional Neuroradiology, E.O. Ospedali Galliera, Genoa, Italy
| | - Antonio Castaldi
- Department of Diagnostic and Interventional Neuroradiology, E.O. Ospedali Galliera, Genoa, Italy
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Chowdhry M, Agrawal S, S ML. A case of Bickerstaff encephalitis with overlapping Gullian Barre syndrome in a pediatric patient treated with therapeutic plasma exchange. Transfus Apher Sci 2021; 60:103260. [PMID: 34521589 DOI: 10.1016/j.transci.2021.103260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
Bickerstaff brain stem encephalitis (BBE) is a rare brainstem disorder characterized by acute onset of ophthalmoplegia, ataxia, and altered consciousness. Guillain Barre syndrome (GBS), Miller Fischer syndrome and BBE share certain similarities such as the presence of anti-ganglioside antibodies. The use of Therapeutic Plasma Exchange (TPE) has been reserved for severe to fulminant cases of BBE mostly as an 'off label' use. The role of TPE in the overlapping syndrome of BBE and GBS has not been explored much, especially in the paediatric population. Herein, we describe a case of 2-year-old male who presented with features of BBE and later evolved to an overlapping syndrome with BBE and GBS. A multi-disciplinary team managed the patient and TPE was initiated as a part of the treatment plan. Five cycles of TPE were done from day 24 after which the patient improved. In our case, TPE was used as rescue therapy in patients with BBE overlapping with GBS. The effectiveness of TPE can be further explored as a modality in such disorders.
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Affiliation(s)
- Mohit Chowdhry
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi, 110076, India.
| | - Soma Agrawal
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi, 110076, India.
| | - Minu Lekshmi S
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, New Delhi, 110076, India.
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Abstract
Autoimmune neurogenic dysphagia refers to manifestation of dysphagia due to autoimmune diseases affecting muscle, neuromuscular junction, nerves, roots, brainstem, or cortex. Dysphagia is either part of the evolving clinical symptomatology of an underlying neurological autoimmunity or occurs as a sole manifestation, acutely or insidiously. This opinion article reviews the autoimmune neurological causes of dysphagia, highlights clinical clues and laboratory testing that facilitate early diagnosis, especially when dysphagia is the presenting symptom, and outlines the most effective immunotherapeutic approaches. Dysphagia is common in inflammatory myopathies, most prominently in inclusion body myositis, and is frequent in myasthenia gravis, occurring early in bulbar-onset disease or during the course of progressive, generalized disease. Acute-onset dysphagia is often seen in Guillain–Barre syndrome variants and slowly progressive dysphagia in paraneoplastic neuropathies highlighted by the presence of specific autoantibodies. The most common causes of CNS autoimmune dysphagia are demyelinating and inflammatory lesions in the brainstem, occurring in patients with multiple sclerosis and neuromyelitis optica spectrum disorders. Less common, but often overlooked, is dysphagia in stiff-person syndrome especially in conjunction with cerebellar ataxia and high anti-GAD autoantibodies, and in gastrointestinal dysmotility syndromes associated with autoantibodies against the ganglionic acetyl-choline receptor. In the setting of many neurological autoimmunities, acute-onset or progressive dysphagia is a potentially treatable condition, requiring increased awareness for prompt diagnosis and early immunotherapy initiation.
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Wong CK, Ng CF, Tan HJ, Mukari SAM. Bickerstaff brainstem encephalitis with Guillain-Barré syndrome overlap following chlamydia infection. BMJ Case Rep 2021; 14:14/5/e242090. [PMID: 34031085 DOI: 10.1136/bcr-2021-242090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bickerstaff brainstem encephalitis (BBE) is a rare autoimmune encephalitis characterised by ataxia, ophthalmoplegia and altered consciousness. An overlap between BBE with Guillain-Barré syndrome (GBS) shows similar clinical and immunological features. We report a case of BBE with GBS overlap secondary to Chlamydia pneumoniae infection. The triad of altered consciousness, ataxia and ophthalmoplegia were present in the patient. The investigations included cerebrospinal fluid cytoalbuminological dissociation, nerve conduction test that showed prolonged or absent F wave latencies, hyperintensity in the left occipital region on brain MRI and diffuse slow activity on the electroencephalogram. The chlamydia serology was positive indicating a postinfectious cause of BBE syndrome. He required artificial ventilation as his consciousness level deteriorated with tetraparesis, oropharyngeal and respiratory muscle weakness. Immunotherapy with intravenous immunoglobulin and methylprednisolone was commenced. He made good recovery with the treatment. Prompt recognition of this rare condition following chlamydia infection is important to guide the management.
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Affiliation(s)
- Chee Keong Wong
- Department of Medicine, Hospital Pulau Pinang, Georgetown, Pulau Pinang, Malaysia
| | - Chen Fei Ng
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Hui Jan Tan
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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Xie J, Zhang T, Liu T. First report of Bickerstaff's brainstem encephalitis caused by Salmonella Dublin: a case report. BMC Neurol 2021; 21:199. [PMID: 33992070 PMCID: PMC8122203 DOI: 10.1186/s12883-021-02230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Diseases caused by nontyphoid Salmonella can range from mild, to self-limiting gastroenteritis and severe invasive infection. Relatively rarely, Salmonella may cause severe encephalopathy. Case presentation We report a suspected case of Bickerstaff’s brainstem encephalitis caused by Salmonella Dublin. A young man presented with impaired consciousness, ataxia, dysarthria, limb weakness, and restricted eyeball abduction. His clinical symptoms were consistent with Bickerstaff’s brainstem encephalitis. Conclusions This is the first case report of Bickerstaff’s brainstem encephalitis caused by Salmonella Dublin in the literature. After treatment, he recovered and was discharged. Early antibiotic treatment of sepsis may control the disease and avoid serious encephalopathy.
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Affiliation(s)
- Jiangbo Xie
- Department of Neurology, Weifang Traditional Chinese Hospital, Weifang, China
| | - Tingting Zhang
- Department of Neurology, Weifang Traditional Chinese Hospital, Weifang, China
| | - Tao Liu
- Department of Neurology, Weifang Traditional Chinese Hospital, Weifang, China.
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Fulminant Guillain-Barré Syndrome Post Hemorrhagic Stroke: Two Case Reports. Neurol Int 2021; 13:190-194. [PMID: 34066316 PMCID: PMC8162529 DOI: 10.3390/neurolint13020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute, immune-mediated inflammatory peripheral polyneuropathy characterized by ascending paralysis. Most GBS cases follow gastrointestinal or chest infections. Some patients have been reported either following or concomitant with head trauma, neurosurgical procedures, and rarely hemorrhagic stroke. The exact pathogenesis is not entirely understood. However, blood-brain barrier damage may play an essential role in triggering the autoimmune activation that leads to post-stroke GBS. Here, we present two cases of fulminant GBS following hemorrhagic stroke to remind clinicians to be aware of this rare treatable complication if a stroke patient develops unexplainable flaccid paralysis with or without respiratory distress.
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Relapsing Bickerstaff Brainstem Encephalitis After Autologous Stem Cell Transplant. J Clin Neuromuscul Dis 2021; 21:225-229. [PMID: 32453098 DOI: 10.1097/cnd.0000000000000282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bickerstaff brainstem encephalitis, widely considered to be associated with Miller Fisher and Guillain-Barré syndromes, is a rare disease state defined by the triad of ophthalmoplegia, ataxia, and decreased consciousness. The presence of central nervous system involvement, commonly in the form of impaired arousal, solidifies it as a unique entity. We present a case of this rare syndrome after autologous stem cell transplant.
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Tan CY, Razali SNO, Goh KJ, Shahrizaila N. Determining the Utility of the Guillain-Barré Syndrome Classification Criteria. J Clin Neurol 2021; 17:273-282. [PMID: 33835749 PMCID: PMC8053556 DOI: 10.3988/jcn.2021.17.2.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background and Purpose Several variants of Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS) exist, but their frequencies vary in different populations and do not always meet the inclusion criteria of the existing diagnostic criteria. However, the GBS classification criteria by Wakerley and colleagues recognize and define the clinical characteristics of each variant. We applied these criteria to a GBS and MFS cohort with the aim of determining their utility. Methods Consecutive GBS and MFS patients presenting to our center between 2010 and 2020 were analyzed. The clinical characteristics, electrophysiological data, and antiganglioside antibody profiles of the patients were utilized in determining the clinical classification. Results This study classified 132 patients with GBS and its related disorders according to the new classification criteria as follows: 64 (48.5%) as classic GBS, 2 (1.5%) as pharyngeal-cervical-brachial (PCB) variant, 7 (5.3%) as paraparetic GBS, 29 (22%) as classic MFS, 3 (2.3%) as acute ophthalmoparesis, 2 (1.5%) as acute ataxic neuropathy, 2 (1.5%) as Bickerstaff brainstem encephalitis (BBE), 17 (12.9%) as GBS/MFS overlap, 4 (3%) as GBS/BBE overlap, 1 (0.8%) as MFS/PCB overlap, and 1 (0.8%) as polyneuritis cranialis. The electrodiagnosis was demyelinating in 55% of classic GBS patients but unclassified in 79% of classic MFS patients. Anti-GM1, anti-GD1a, anti-GalNAc-GD1a, and anti-GD1b IgG ganglioside antibodies were more commonly detected in the axonal GBS subtype, whereas the anti-GQ1b and anti-GT1a IgG ganglioside antibodies were more common in classic MFS and its subtypes. Conclusions Most of the patients in the present cohort met the criteria of either classic GBS or MFS, but variants were seen in one-third of patients. These findings support the need to recognize variants of both syndromes in order to achieve a more-complete case ascertainment in GBS.
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Affiliation(s)
- Cheng Yin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Siti Nur Omaira Razali
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean Jin Goh
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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45
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Raibagkar P, Ramineni A. Autoimmune Neurologic Emergencies. Neurol Clin 2021; 39:589-614. [PMID: 33896534 DOI: 10.1016/j.ncl.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past decade, understanding of autoimmune neurologic disorders has exponentially increased. Many patients present as a neurologic emergency and require timely evaluation with rapid management and intensive care. However, the diagnosis is often either missed or delayed, which may lead to a significant burden of disabling morbidity and even mortality. A high level of suspicion in the at-risk population should be maintained to facilitate more rapid diagnosis and prompt treatment. At present, there is no all-encompassing algorithm specifically applicable to the management of fulminant autoimmune neurologic disorders. This article discusses manifestations and management of various autoimmune neurologic emergencies.
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Affiliation(s)
- Pooja Raibagkar
- Concord Hospital Neurology Associates, 246 Pleasant Street, Concord, NH 03301, USA.
| | - Anil Ramineni
- Lahey Hospital & Medical Center, Beth Israel Lahey Health, 41 Mall Road, Burlington, MA 01803, USA
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Natsui H, Takahashi M, Nanatsue K, Itaya S, Abe K, Inaba A, Orimo S. Mother and son cases of Bickerstaff's brainstem encephalitis and fisher syndrome with serum anti-GQ1b IgG antibodies: a case report. BMC Neurol 2021; 21:130. [PMID: 33743625 PMCID: PMC7980323 DOI: 10.1186/s12883-021-02159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Bickerstaff’s brainstem encephalitis (BBE) and Fisher syndrome (FS) are immune-mediated diseases associated with anti-ganglioside antibodies, specifically the anti-GQ1b IgG antibody. These two diseases potentially lie on a continuous spectrum with Guillain-Barré Syndrome (GBS). There are some reports of family cases of GBS and fewer of FS. However, there are no reports of family cases of BBE and FS. Case presentation We report a familial case of an 18-year-old son who had BBE and his 52-year-old mother diagnosed with FS within 10 days. The son showed impaired consciousness 1 week after presenting with upper respiratory symptoms and was brought to our hospital by his mother. He showed decreased tendon reflexes, limb ataxia, albuminocytologic dissociation in his spinal fluid, and positive serum anti-GQ1b antibodies. Haemophilus influenzae was cultured from his sputum. He was diagnosed with BBE and treated with intravenous immunoglobulin (IVIg) therapy, which led to an improvement in symptoms. The mother presented with upper respiratory symptoms 3 days after her son was hospitalized. Seven days later, she was admitted to the hospital with diplopia due to limited abduction of the left eye. She showed mild ataxia and decreased tendon reflexes. Her blood was positive for anti-GQ1b antibodies. She was diagnosed with FS and treated with IVIg, which also led to symptomatic improvement. Conclusions There are no previous reports of familial cases of BBE and FS; therefore, this valuable case may contribute to the elucidation of the relationship between genetic predisposition and the pathogenesis of BBE and FS.
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Affiliation(s)
- Hirokazu Natsui
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Makoto Takahashi
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan.
| | - Kentaro Nanatsue
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Sakiko Itaya
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Keisuke Abe
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Akira Inaba
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
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Yoshimura H, Togo M, Ishii J, Ishiyama H, Tamura R, Kimura M, Kuroda T, Kusunoki S, Kawamoto M, Kohara N. Electroencephalographic findings in Bickerstaff's brainstem encephalitis: A possible reflection of the dysfunction of the ascending reticular activating system. Clin Neurophysiol Pract 2021; 6:29-35. [PMID: 33490740 PMCID: PMC7809243 DOI: 10.1016/j.cnp.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/10/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022] Open
Abstract
BBE impairs the ascending reticular activating system, and causes EEG changes. Stereotypical EEG changes correlating with the level of consciousness were observed. Characteristic “unarousable sleep-like” EEG can be a diagnostic clue for BBE.
Objectives Bickerstaff’s brainstem encephalitis (BBE) is a rare post-infectious inflammatory disease, which causes impaired consciousness by the dysfunction of the ascending reticular activating system (ARAS). We aimed to clarify EEG changes possibly caused by the dysfunction of the ARAS in BBE. Methods We retrospectively investigated 15 EEGs from 5 patients with definite BBE (i.e., the positivity for serum IgG anti-GQ1b antibodies was mandatory for the diagnosis) admitted to our hospital from January 2014 through December 2019, particularly focusing on whether N1 and N2 sleep patterns were maintained. Results All of the 10 EEGs recorded when patients had consciousness disturbance were abnormal. Stereotypical EEG changes correlating with their level of consciousness were identified: poorly organized posterior dominant rhythms with maintenance of sleep patterns in patients with mild consciousness disturbance (n = 5); predominant N1 and/or N2 sleep patterns even with external stimuli, including spindle coma pattern, in patients with moderate consciousness disturbance (“unarousable sleep-like” EEG) (n = 4); and generalized slow waves without N1 and N2 sleep patterns in patients with severe consciousness disturbance (n = 1). Among 5 patients, 3 (60%) had “unarousable sleep-like” EEG in their clinical course. Conclusions Patients with BBE showed stereotypical EEG changes correlating with their level of consciousness, mostly with maintenance of N1 and N2 sleep patterns, and often exhibited characteristic “unarousable sleep-like” EEG. Significance This study revealed characteristic EEG changes possibly caused by the dysfunction of the ARAS, which can be a diagnostic clue for BBE.
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Affiliation(s)
- Hajime Yoshimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Masaya Togo
- Department of Neurology, Kobe City Medical Center General Hospital, Japan.,Division of Neurology, Kobe University Graduate School of Medicine, Japan
| | - Junko Ishii
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Hiroyuki Ishiyama
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Ryota Tamura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan.,Department of Neurology, Shiga University of Medical Science, Japan
| | - Masamune Kimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Takehito Kuroda
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University, Faculty of Medicine, Japan
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
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Abstract
Rhomboencephalitis-inflammation of the brainstem and cerebellum-has myriad clinical presentations including encephalopathy, cranial neuropathies, long tract signs and cerebellar dysfunction and is associated with significant morbidity and mortality. There are a variety of potential underlying causes that respond variably to treatment, including infections, parainfective syndromes, inflammatory disorders including autoimmune encephalitis and paraneoplastic syndromes. Here, we review its clinical presentation and outline a practical approach to its investigation, aiming to facilitate prompt diagnosis and confirmation of the underlying cause, to start appropriate management early and optimise the clinical outcome.
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Affiliation(s)
- Jonathan Cleaver
- Department of Neurology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department of Neurology, North Bristol NHS Trust, Bristol, UK
| | - Richard James
- Department of Neuroradiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Claire M Rice
- Department of Neurology, North Bristol NHS Trust, Bristol, UK
- Clinical Neuroscience, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Mulroy E, Anderson NE. Altered mental status in "Guillain-Barré syndrome" -a noteworthy clinical clue. Ann Clin Transl Neurol 2020; 7:2489-2507. [PMID: 33136342 PMCID: PMC7732251 DOI: 10.1002/acn3.51226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/19/2020] [Accepted: 09/26/2020] [Indexed: 01/01/2023] Open
Abstract
Guillain‐Barré syndrome (GBS) is widely regarded as a “pure” peripheral nervous system disorder. However, this simplistic interpretation belies the fact that central nervous system involvement, often manifesting as derangements in mental status can occur as a complication of the “pure” form of the disorder, as part of GBS variants, as well as in a number of mimic disorders. Despite being common in clinical practice, there is no guidance in the literature as to how to approach such scenarios. Herein, we detail our approach to these cases.
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Affiliation(s)
- Eoin Mulroy
- UCL Queen Square Institute of Neurology, London, UK
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Cleaver J, James R, Chohan G, Lyons P. Bickerstaff's brainstem encephalitis associated with anti-GM1 and anti-GD1a antibodies. BMJ Case Rep 2020; 13:e236545. [PMID: 32948528 PMCID: PMC7511636 DOI: 10.1136/bcr-2020-236545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 11/03/2022] Open
Abstract
Bickerstaff's brainstem encephalitis (BBE) is a Guillain-Barré syndrome (GBS) spectrum disorder associated with predominantly central nervous system predilection. Patients exhibit a variable constellation of depressed consciousness, bilateral external ophthalmoplegia, ataxia and long tract signs. Although the pathophysiology is not fully understood, it has been associated with anti-GQ1b antibodies in two-thirds of patients. We present a patient with clinical features consistent with BBE and positive anti-GM1 and anti-GD1a antibodies. A diagnostic approach to the acutely unwell patient with brainstem encephalitis is explored in this clinical context with a literature review of the aforementioned ganglioside antibody significance. Intravenous immunoglobulin therapy is highlighted in BBE using up-to-date evidence-based extrapolation from GBS.
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Affiliation(s)
- Jonathan Cleaver
- Department of Neurology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Richard James
- Department of Neuroradiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Gurjit Chohan
- Department of Neurology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Paul Lyons
- Department of Neurology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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