Bickerstaff's brainstem encephalitis: can it recur?

Bickerstaff's brain-stem encephalitis is usually a monophasic post-viral inflammatory illness characterized by progressive ophthalmoplegia, ataxia and disturbance of consciousness (or hyper-reflexia). Since the clinical spectrum of Bickerstaff encephalitis may overlap with the Miller-Fisher and Guillain-Barre syndromes, the presence of anti-GQIb antibodies and abnormal brain MRI can help to support its diagnosis. However, absence of anti-GQIb antibodies and normal MRI do not exclude the diagnosis, which remains based on clinical criteria and exclusion of other etiologies. We report a case of recurrent Bickerstaff's brainstem encephalitis with no identifiable antecedent illness, and overlapping features of Miller Fisher and Guillain-Barre syndromes, in the presence of negative anti-GQIb antibodies and repeatedly normal MRI of the brain. (c) 2005 Elsevier Ltd. All rights reserved.