Kitazawa K, Yuki N
Department of Pediatrics, Asahi General Hospital.
Rinsho Shinkeigaku. 1995 Jun;35(6):626-32.
A 14-year-old girl developed diplopia and ataxic gait following upper respiratory tract infection. On day 3, she became lethergic, but was easily roused on stimulation. Neurologic examinations showed external ophthalmoplegia, tetraplegia, tendon areflexia, and extensor plantar responses. CSF protein was 93 mg/dl with normal cellurality on day 25. Serum in the acute phase of her illness had autoantibodies to gangliosides GQ1b and Ga1NAc-GD1a. An EEG showed bilateral theta activity. Results of ABR, SEP and blink reflexes suggested the presence of intramedullary brainstem lesion. She received plasmapheresis on days 4, 5 and 6. Neurological signs immediately improved. Five months after onset of neurological symptoms, she had no neurological abnormalities except for tendon areflexia. Electrophysiologic studies returned to normal concurrently with her clinical improvement. This patient demonstrates an overlap between Guillain-Barré syndrome and Bickerstaff's brainstem encephalitis.
一名14岁女孩在上呼吸道感染后出现复视和共济失调步态。第3天，她变得嗜睡，但刺激后很容易被唤醒。神经系统检查显示眼球外肌麻痹、四肢瘫、腱反射消失和跖伸反应。第25天脑脊液蛋白为93mg/dl，细胞计数正常。她患病急性期的血清中有针对神经节苷脂GQ1b和Ga1NAc-GD1a的自身抗体。脑电图显示双侧θ活动。听觉脑干诱发电位（ABR）、体感诱发电位（SEP）和瞬目反射结果提示存在髓内脑干病变。她在第4、5和6天接受了血浆置换。神经体征立即改善。神经症状出现5个月后，除腱反射消失外，她没有神经异常。电生理研究随着她的临床改善而恢复正常。该患者表现出海兰-巴雷综合征和比克斯特法夫脑干脑炎之间的重叠。
