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Case report
Bickerstaff’s brainstem encephalitis associated with anti-GM1 and anti-GD1a antibodies
  1. Jonathan Cleaver1,
  2. Richard James2,
  3. Gurjit Chohan1 and
  4. Paul Lyons1
  1. 1Department of Neurology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
  2. 2Department of Neuroradiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
  1. Correspondence to Dr Jonathan Cleaver; jonathan.cleaver{at}


Bickerstaff’s brainstem encephalitis (BBE) is a Guillain-Barré syndrome (GBS) spectrum disorder associated with predominantly central nervous system predilection. Patients exhibit a variable constellation of depressed consciousness, bilateral external ophthalmoplegia, ataxia and long tract signs. Although the pathophysiology is not fully understood, it has been associated with anti-GQ1b antibodies in two-thirds of patients. We present a patient with clinical features consistent with BBE and positive anti-GM1 and anti-GD1a antibodies. A diagnostic approach to the acutely unwell patient with brainstem encephalitis is explored in this clinical context with a literature review of the aforementioned ganglioside antibody significance. Intravenous immunoglobulin therapy is highlighted in BBE using up-to-date evidence-based extrapolation from GBS.

  • neurology
  • brain stem / cerebellum
  • cranial nerves
  • neuro ITU

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  • Contributors JC, GC and PL contributed to the manuscript rationale and patient management. JC created the first draft. GC, PL and RJ revised the manuscript. RJ contributed to manuscript images and descriptions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.