An elderly patient with Bickerstaff brainstem encephalitis and transient episodes of brainstem dysfunction.

BACKGROUND Bickerstaff brainstem encephalitis (BBE) is a rare inflammatory, demyelinating disease that generally has a good prognosis. OBJECTIVE To describe the course of a patient with severe BBE and multiple medical complications. DESIGN Case report. SETTING Academic medical center. PATIENT An 81-year-old woman with BBE who fully recovered. The patient had transient and very frequent episodes of brainstem dysfunction during the recovery phase. MAIN OUTCOME MEASURES Clinical and biochemical evaluation with magnetic resonance imaging. CONCLUSIONS Bickerstaff brainstem encephalitis is a potentially reversible syndrome that needs early diagnosis (facilitated by magnetic resonance imaging) and prompt aggressive and supportive treatment. Frequent episodes of transient brainstem dysfunction occurred in our patient during recovery, possibly due to ephaptic transmission.