Bickerstaff brainstem encephalitis (BBE) is a rare autoimmune neurological disease characterized by a triad of acute eye muscle weakness (ophthalmoplegia), ataxia, and altered consciousness, with positive serum IgG anti-GQ1b and negative anti-N-methyl-D-aspartate (NMDA) receptor antibodies.

[0:00] This video shows an unusual manifestation of the disorder in a previously healthy 20-year-old woman.

[0:03]: On day 1, the patient presented with bilateral ptosis, severe external ophthalmoplegia in all eye muscles, and facial grimacing and sniffing motions.

[0:29]: By day 5, she developed slow and restless movements in her lower limbs and rapid neck twisting.

[0:56]: On day 7, abnormal movements appeared in her upper limbs, and her consciousness disturbance and ophthalmoplegia improved.

The abnormal movements are unusual for BBE and are more characteristic of anti-NMDA encephalitis. The patient returned to normal after treatment with intravenous immunoglobulin and methylprednisolone.

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