Acute Autoimmune Encephalitis With Features of Bickerstaff Brainstem Encephalitis (BBE) and Two Abnormal Autoantibodies Presenting With Prominent Cerebellar Abnormality on MRI–A Case Report

Objective To present an unusual cerebellar imaging finding of a patient with clinical features BBE Background is characterized by progressive ataxia, ophthalmoplegia and impaired consciousness. Magnetic resonance (MRI) the brain usually normal. However, rare T2 Flair changes have been reported. Scarcity findings on led to controversy peripheral vs central etiology for ataxia. Despite other modalities including positron emission tomography, magnetic spectroscopy molecular level evidence pointing towards involvement cerebellum, MRI unrevealing. Design/Methods A 62-year-old woman presented acute onset ataxia multiple falls, dysarthria, diplopia, blurred vision that started 3 days prior presentation. She had left face angioedema couple after her flu inoculation 6 weeks Her exam revealed normal mental status, scanning speech, bilateral dysmetria as well left-sided facial palsy, square wave jerks hyperreflexia. CSF showed 30 RBC, 17 WBC, glucose, elevated protein 68 mg/dl. No infectious etiologies were identified. infratentorial leptomeningeal enhancement hyperintensities in both hemispheres. Anti-GQ1b antibodies 51 IV (negative < IV) anti-GAD65 also weakly positive only serum, 0.12 nmol/L 0.02 nmol/L). Results was diagnosed autoimmune encephalitis treated methylprednisolone IVIG. rapidly improved clinically, resolved. Conclusions We demonstrated prominent good recovery anti-GQ1b mild seropositive encephalitis. Our case first reported double direct