PT  - JOURNAL ARTICLE
AU  - Bhatia, Sehajdev Singh
AU  - Canepa, Carlo
AU  - Notarianni, Asha
TI  - Bickerstaff’s brainstem encephalitis mimicking herpetic encephalomyelitis in a liver transplant patient with anti-GQ1b antibodies
AID  - 10.1136/bcr-2022-251784
DP  - 2022 Dec 01
TA  - BMJ Case Reports
PG  - e251784
VI  - 15
IP  - 12
4099  - http://casereports.bmj.com/content/15/12/e251784.short
4100  - http://casereports.bmj.com/content/15/12/e251784.full
SO  - BMJ Case Reports2022 Dec 01; 15
AB  - A woman in her late 70s with a history of liver transplant presented with ophthalmoplegia, ataxia, areflexia, positive Babinski’s sign and reduced consciousness. This followed an antecedent illness in the form of a herpes zoster infection. MRI of the brain/spinal cord, cerebrospinal fluid analysis with viral PCR and routine blood tests were normal, and tacrolimus neurotoxicity was ruled out. Serum anti-GQ1b antibodies were positive. A diagnosis of Bickerstaff’s brainstem encephalitis was made, forming part of the continuum that involves Miller-Fisher syndrome, entitled the ‘anti-GQ1b syndrome’. Complete recovery ensued without intravenous immunoglobulins or plasma exchange. The role of monitoring anti-ganglioside pattern change to predict or confirm disease recurrence and disease severity is further discussed.