Bickerstaff’s Brainstem Encephalitis Suspected as Functional Neurologic Disorders

Abstract

Hiroaki Okayasu,1 Norio Yasui-Furukori,1 Taro Kadowaki,2 Kei Funakoshi,2 Koichi Hirata,2 Kazutaka Shimoda1 1Department of Psychiatry, Dokkyo Medical University, Tochigi, Japan; 2Department of Neurology, Dokkyo Medical University, Tochigi, JapanCorrespondence: Hiroaki Okayasu Tel [phone]Email [email protected]: Functional neurologic disorders feature nervous system symptoms that cannot be explained by a neurological disease or other medical condition. The patient described here was a 21-year-old Japanese woman who was initially diagnosed with a functional neurologic disorder based on numbness and weakness of the limbs with no abnormalities in routine examinations. Further detailed examinations revealed monocytes in cerebrospinal fluid (CSF), and electroencephalography revealed widespread, low-voltage, slow waves with concentrated spindle waves. Thus, encephalitis was suspected, and steroid pulse therapy was initiated. Her symptoms subsequently improved. Afterward, CSF analysis was positive for serum anti-GQ1b IgG antibodies. We made a final diagnosis of Bickerstaff’s brainstem encephalitis (BBE). Our report describes the difficult differentiation of functional neurologic disorders from BBE. Physicians and psychiatrists should be aware of BBE.Keywords: Bickerstaff’s brainstem encephalitis, functional neurologic disorder, Guillain-Barré syndrome, Miller Fisher syndrome, consciousness disturbance

Keywords

• bickerstaff’s brainstem encephalitis
• functional neurologic disorder
• guillain-barré syndrome
• miller fisher syndrome
• consciousness disturbance