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. 2025 Jul 2;12(1):e70071.
doi: 10.1002/ams2.70071. eCollection 2025 Jan-Dec.

Bickerstaff brainstem encephalitis developed quickly after COVID-19 infection

Daiki Mori  1 , Takahiro Yamada  1 , Hiroshi Fukuma  1 , Shota Nakao  1 , Tetsuya Matsuoka  1
Affiliations

Bickerstaff brainstem encephalitis developed quickly after COVID-19 infection

Daiki Mori et al. Acute Med Surg. .

Abstract

Background: Bickerstaff brainstem encephalitis (BBE) is an autoimmune disease characterized by impaired consciousness, ophthalmoplegia, and ataxia. We report two cases of BBE following COVID-19.

Case presentation: Case 1: A 51-year-old male was diagnosed with COVID-19 4 days after fever. He had prolonged loss of consciousness, and developed ophthalmoplegia and ataxia. He was treated with steroids and immunoglobulin, which improved his consciousness. Case 2: A 28-year-old female was diagnosed with COVID-19 because of fever 4 days after contact with a COVID-19 patient. She suffered from prolonged loss of consciousness, ophthalmoplegia, and myoclonus. She was treated with steroids, immunoglobulin, and plasmapheresis, which ameliorated her consciousness.

Conclusion: Both patients developed central nervous system (CNS) symptoms within a week of COVID-19 onset, indicating that BBE develops immediately after prior infection. This disease should be considered if CNS symptoms appear rapidly after COVID-19.

Keywords: autoimmune disease; central nervous system symptoms; early diagnosis; prior infection.

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Conflict of interest statement

Dr. Tetsuya Matsuoka is an Editorial Board member of AMS Journal and a co‐author of this article. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication.

Figures

FIGURE 1
FIGURE 1
MRI of the brain (Case 1). Magnetic resonance imaging showed no abnormal findings (A–D: Day 8, E–H: Day 14).
FIGURE 2
FIGURE 2
MRI of the brain (Case 2). Magnetic resonance imaging showed high signal in the midbrain (A–D: Day 31).
See this image and copyright information in PMC

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