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>Journals >Medicina Interna de México >Year 2014, Issue 5

Lule-Alatorre KP, Domínguez-Borgua A, Martín-Ramírez JF, López-Galicia DN, Vázquez-Flores AD, Zaldívar-Clavellina AK
Bickerstaff: Brainstem encephalitis
Med Int Mex 2014; 30 (5)

Language: Español
References: 26
Page: 575-583
PDF: 449.56 Kb.

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In 1950 decade, Bickerstaff described a clinical setting preceded most cases by a febrile disease, that since its beginning shows evidence of participation of the brain stem, followed by a stationary period of 1-to-3 weeks and later spontaneous remission during several months, in which patient has somnolence as initial sign and data of central and peripheral nervous system compromise; he also described changes on cefaloraquid liquid and the electroencephalogram of these patients. Annual incidence of Bickerstaff encephalitis is calculated in 0.078 per 100,000 habitants, with a mild predominance of men (relation man:woman 1.3:1), with an average age of 39 years (median of 35 years). A great number of affected patients shows antibody anti-GQ1b; due to this seropositivity is observed in other diseases, such as Guillain-Barre and Miller-Fisher syndromes, many physicians believe that it forms part of the called anti-GQ1b syndromes. However, it has some different pathophysiological mechanisms that are responsible of the clinical and laboratory and imaging studies differences. Generally, it has been suggested the same treatment than that against other anti-GQ1b syndromes, but some ongoing studies propose a specific treatment against the pathophysiologic mechanism triggering Bickerstaff's encephalitis.

Key words: Bickerstaff's brainstem encephalitis, anti-GQ1b IgG antibody, anti-GQ1b syndrome.


  1. Shahrizaila N, Yuki N. Review Bickerstaff brainstem encephalitis and Fisher syndrome: anti-GQ1b antibody syndrome. J Neurol Neurosurg Psychiatry 2013;84:576-583.

  2. Bickerstaff E, Cloake P. Mesencephalitis and rhombencephalitis. Br Med J 1951;2:77-81.

  3. Bickerstaff E. Brain-stem encephalitis: further observations on a grave syndrome with benign prognosis. Br Med J 1957;1:1384-1387.

  4. Miller C. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). N Engl J Med 1956;255:57-65.

  5. Deschle F, di Pace J, Carnero E, Hryb J, Perassolo M. Síndrome de Fisher-Bickerstaff: espectro clínico del anti-GQ1b. Neurol Arg 2013.

  6. Hasegawa Y, Kawabata K, Nakai N, Tujimoto M, Takahashi A. Paralytic mydriasis in Bickerstaff brainstem encephalitis. Report of three cases. Autonomic neuroscience: Basic and clinical US 2013;177:53.

  7. Koga M, Kusunoki S, Kaida K, Uehara R, et al. Research paper. Nationwide survey of patients in Japan with Bickerstaff brainstem encephalitis: epidemiological and clinical characteristics. J Neurol Neurosurg Psychiatry 2012;83:1210-1215.

  8. Shameem R, Sonpal N, Hamid M, Orsher S, et al. Bickerstaff’s brainstem encephalitis: A rare variant of the anti-Gq1b antibody syndrome. Practical Neurology 2013;28-31.

  9. Yuki N, Shahrizaila N. How do we identify infectious agents that trigger Guillain-Barre syndrome, Fisher syndrome and Bickerstaff brainstem encephalitis? J Neurol Sci 2011;1-5.

  10. Yuki N, Hartung H. Guillain-Barré syndrome. N Engl J Med 2012;366:2294-2304.

  11. Yuki N. Fisher syndrome and Bickerstaff brainstem encephalitis (Fisher-Bickerstaff syndrome). J Neuroimmunol 2009;215:1-9.

  12. Yuki N, Hattori T, Kuwabara S. Bickerstaff's brainstem encephalitis after an outbreak of Campylobacter jejuni Mori M, Koga enteritis. J Neuroimmunol 2008;196:143-146.

  13. Saito K, Shimizu F, Koga M, Sano Y, et al. Research paper blood–brain barrier destruction determines Fisher/Bickerstaff clinical phenotypes: an in vitro study. J Neurol Neurosurg Psychiatry 2013;84:756-765.

  14. Yuki N. Fisher syndrome and Bickerstaff brainstem encephalitis (Fisher-Bickerstaff syndrome). J Neuroimmunol 2009;215:1-9.

  15. Yuki N, Hirata K. Complement activation by anti-GQ1b antibodies in Fisher syndrome and its variants. J Neuroimmunol 2013;258:100-101.

  16. Debreczeni R, Orosz P, Bihari J, Bereczki D. Bickerstaff brainstem encephalitis-A case report. J Neurol Sci 2013;629-678.

  17. Odaka M, Yuki N, Yamada M, Koga M, et al. Bickerstaff’s brainstem encephalitis: clinical features of 62 cases and a subgroup associated with Guillain-Barre syndrome. Brain 2003;126:2279-2290.

  18. Dong H, Liu Z, Tang Y, Lu Y, et al. Recurrent Fisher-Bickerstaff syndrome: report of a Chinese case. Chin Med J 2011;124:2786-2788.

  19. Travasarou M, Kitsos D, Marousi S, Panagopoulos G, et al. Atypical Bickerstaff's brainstem encephalitis: Clinical vigilance ensures favourable prognosis. J Neurol Sci 2013;629-678.

  20. Lee S, Lim G, Kim J, Oh S, et al. Acute ophthalmoplegia (without ataxia) associated with anti-GQ1b antibody. Neurology 2008;71:426-429.

  21. Wakerley B, Soon D, Chan Y, Yuki N. Atypical Bickerstaff brainstem encephalitis: ataxic hypersomnolence without ophthalmoplegia. J Neurol Neurosurg Psychiatry 2013;84:1206-1207.

  22. Wada Y, Yanagihara C, Nishimura Y, Funakoshi K, Odaka M. Delirio en dos pacientes con encefalitis de Bickerstaff. J Neurol Sci 2008;269:184-186.

  23. Weidauer S, Ziemann U, Thomalske C, Gaa J, et al. Vasogenic edema in Bickerstaff's brainstem encephalitis. A serial MRI study. Neurology 2003;61:836-838.

  24. Cho J, Kim G, Choi S, Lee J. The brainstem auditory evoked potentials in two cases of Bickerstaffs brainstem encephalitis. Clin Neurophysiol 2010;121:216.

  25. Kuwabara S, Misawa S, Mori M. Is “Bickerstaff brainstem encephalitis” really encephalitis? J Neurol Neurosurg Psychiatry 2013;7:712.

  26. Hardy T, Barnett M, Mohamed A, Garsia R, Davies L. Severe Bickerstaff's encephalitis treated with Rituximab: Serum and CSF GQ1b antibodies. J Neuroimmunol 2012;251:107-109.

>Journals >Medicina Interna de México >Year 2014, Issue 5

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