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Bickerstaff brainstem encephalitis with Guillain-Barré syndrome overlap following chlamydia infection
  1. Chee Keong Wong1,
  2. Chen Fei Ng2,
  3. Hui Jan Tan2 and
  4. Shahizon Azura Mohamed Mukari2
  1. 1Department of Medicine, Hospital Pulau Pinang, Georgetown, Pulau Pinang, Malaysia
  2. 2Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
  1. Correspondence to Professor Hui Jan Tan; tanhuijan{at}


Bickerstaff brainstem encephalitis (BBE) is a rare autoimmune encephalitis characterised by ataxia, ophthalmoplegia and altered consciousness. An overlap between BBE with Guillain-Barré syndrome (GBS) shows similar clinical and immunological features. We report a case of BBE with GBS overlap secondary to Chlamydia pneumoniae infection. The triad of altered consciousness, ataxia and ophthalmoplegia were present in the patient. The investigations included cerebrospinal fluid cytoalbuminological dissociation, nerve conduction test that showed prolonged or absent F wave latencies, hyperintensity in the left occipital region on brain MRI and diffuse slow activity on the electroencephalogram. The chlamydia serology was positive indicating a postinfectious cause of BBE syndrome. He required artificial ventilation as his consciousness level deteriorated with tetraparesis, oropharyngeal and respiratory muscle weakness. Immunotherapy with intravenous immunoglobulin and methylprednisolone was commenced. He made good recovery with the treatment. Prompt recognition of this rare condition following chlamydia infection is important to guide the management.

  • neuroopthalmology
  • infection (neurology)
  • peripheral nerve disease

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  • Contributors HJT and CKW was responsible for the planning and writing of the manuscript. CFN was responsible for the analysis of the case. SAMM was responsible for the conception of the case.

  • 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.

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

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