Service of Neurology, S. Maria del Prato Hospital, Feltre, Italy.
Neurol Sci. 2011 Dec;32(6):1153-6. doi: 10.1007/s10072-011-0598-0. Epub 2011 May 10.
A 21-year-old healthy female suffered from an upper respiratory tract infection and 2 days later developed diplopia, unsteady gait, dysarthria and a profound disturbance of consciousness with rapid development of coma. Brain MRI and Tc99m brain perfusion SPECT, EEG, neurophysiological tests and CSF analysis results were unspecific. The detection of serum anti-GQ1b IgG autoantibodies at high titre led to the diagnosis of Bickerstaff's brainstem encephalitis (BBE). Clinical symptoms resolved after treatment with plasma exchange and the outcome was good. Brain MRI was normal, and Tc99m brain perfusion SPECT demonstrated hypoperfusion of the whole cerebral hemispheres and basal ganglia with relative sparing of the thalami and the brainstem. Similar to brain MRI, the sensitivity of Tc99m brain perfusion SPECT in detecting brainstem lesions in typical BBE patients seems to be low.
一位 21 岁健康女性因上呼吸道感染，2 天后出现复视、步态不稳、构音障碍和意识严重障碍，迅速发展为昏迷。脑 MRI 和 Tc99m 脑灌注 SPECT、EEG、神经生理检查和 CSF 分析结果均无特异性。血清抗 GQ1b IgG 自身抗体高滴度检测导致 Bickerstaff 脑干脑炎（BBE）的诊断。经血浆置换治疗后，临床症状缓解，预后良好。脑 MRI 正常，Tc99m 脑灌注 SPECT 显示全脑和基底节区灌注不足，丘脑和脑干相对保留。与脑 MRI 类似，Tc99m 脑灌注 SPECT 对典型 BBE 患者脑干病变的敏感性似乎较低。
