A Case of Bickerstaff Brainstem Encephalitis Presenting With Acute Confusion and Bilateral Facial Paralysis: A Diagnostic and Therapeutic Approach

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Published: Sep 30, 2024
DOI: https://doi.org/10.47836/mjmhs20.5.51
Keywords:
Bickerstaff brainstem encephalitis, Facial paralysis, Bulbar palsy, Ophthalmoplegia, Guillain-barré syndrome

Main Article Content

Fan Kee Hoo
Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
Wan Aliaa Wan Sulaiman
Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
Liyana Najwa Inche Mat
Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
Wei Chao Loh
Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
Hamidon Basri
Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.

Abstract

Bickerstaff brainstem encephalitis (BBE) is a variant of Guillain-Barré syndrome (GBS) characterized by inflammation of the brainstem and cranial nerves. We describe a 60-year-old man presenting with acute confusion, bilateral progressive facial drooping, difficulty swallowing, aphasia, and confusion over two days. Examination showed bilateral facial paralysis, impaired eye movements, ptosis, dysarthria, diminished gag reflex and fatigue. MRI brain was unremarkable. Intravenous immunoglobulin (IVIG) was promptly started with noticeable improvement in facial strength and swallowing by day three. At discharge two weeks later, he had near complete resolution. BBE likely involves autoantibodies triggered by infections causing nerve inflammation. Diagnosis is clinical based on bilateral facial and bulbar weakness. Early immunotherapy provides best recovery prospects. Further research can uncover immunological mechanisms to guide treatments. Optimized protocols tailored to BBE compared with GBS are needed. Distinguishing BBE facilitates prompt therapy and favourable outcomes from this rare syndrome.

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How to Cite
Hoo, F. K., Wan Sulaiman, W. A., Inche Mat, L. N., Loh, W. C., & Basri, H. (2024). A Case of Bickerstaff Brainstem Encephalitis Presenting With Acute Confusion and Bilateral Facial Paralysis: A Diagnostic and Therapeutic Approach. Malaysian Journal of Medicine and Health Sciences, 20(5), 427–429. https://doi.org/10.47836/mjmhs20.5.51
Issue
Vol. 20 No. 5 (2024)
Section
Case Report
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