Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Dec;44(12):4179-4182.
doi: 10.1007/s10072-023-07142-8. Epub 2023 Oct 27.

Delayed onset Bickerstaff brainstem encephalitis overlapping Miller-Fisher Syndrome during SARS-CoV-2 infection

R Acampora  1 , A de Falco  2 , F Lanfranchi  3 , S Montella  2 , R Scala  2 , M Lieto  2 , L Durante  2 , R Bruno  2
Affiliations
Case Reports

Delayed onset Bickerstaff brainstem encephalitis overlapping Miller-Fisher Syndrome during SARS-CoV-2 infection

R Acampora et al. Neurol Sci. 2023 Dec.

Abstract

Bickerstaff brainstem encephalitis (BBE) is a neuroimmunologic disease characterized by the acute onset of external ophthalmoplegia, ataxia, and consciousness disturbance, mostly subsequent to an infection. BBE is considered to be a variant of Miller-Fisher syndrome (MFS), which also exhibits external ophthalmoplegia and ataxia but not presenting consciousness alterations. Therefore, these two medical conditions are included in the clinical spectrum of the "Fisher-Bickerstaff syndrome" ( Shahrizaila and Yuki in J Neurol Neurosurg Psychiatry 84(5):576-583) [1]. With regard to the etiopathogenesis, increasing evidence worldwide suggests that SARS-CoV-2 infection-enhanced immune response is involved in a wide range of neurological complications such as Guillain-Barré syndrome (GBS), MFS, acute necrotizing encephalitis (ANE), myelitis, acute disseminated encephalomyelitis (ADEM), and, although very rarely, BBE either (Hosseini et al. in Rev Neurosci 32:671-691) [2]. We report a case of a patient affected by delayed onset BBE overlapping MFS during a mild SARS-CoV-2 infection. To the best of our knowledge, similar cases have never been reported.

Keywords: BBE; COVID-19; MFS.

PubMed Disclaimer

References

    1. Shahrizaila N, Yuki N (2013) Bickerstaff brainstem encephalitis and Fisher syndrome: anti-GQ1b antibody syndrome. J Neurol Neurosurg Psychiatry 84(5):576–583. https://doi.org/10.1136/jnnp-2012-302824
    1. Hosseini N, Nadjafi S, Ashtary B (2021) Overview of COVID-19 and neurological complications. Rev Neurosci 32(6):671–691. https://doi.org/10.1515/revneuro-2020-0116 - DOI - PubMed
    1. Krihara T, Igarashi Y, Kobai K, Mizobuchi T, Ishii H, Matsumoto N, Yokobori S, Yokota H (2020) Diagnosis and prediction of prognosis for Bickerstaff’s brainstem encephalitis using auditory brainstem response: a case report. Acute Med Surg. 7(1):e517. https://doi.org/10.1002/ams2.517 - DOI
    1. Koga M (2013) Bickerstaff brainstem encephalitis: epidemiology, diagnosis, and therapy. Nihon Rinsho 71(5):898–903 - PubMed
    1. Odaka M, Yuki N, Hirata K (2001) Anti-GQ1b IgG antibody syndrome: clinical and immunological range. J Neurol Neurosurg Psychiatry 70:50–55

Publication types