Bickerstaff Brainstem Encephalitis in a Child: A Case Report

Background: Bickerstaff brainstem encephalitis (BBE) is a rare neurological disorder of autoimmune etiology characterized by ophthalmoplegia, ataxia, and impaired consciousness. Although well documented in adults, it is rarely reported in children. Clinical Description: A 10-year-old boy presented with difficulty in walking, drooping of eyelids, double vision, developing acutely over 6–10 days, associated with altered sensorium for 1 day. On examination, he was drowsy, but hemodynamically stable, having bilateral ptosis and ophthalmoplegia, absent light and corneal reflexes, with drooling of saliva. Tone and power of lower limbs were reduced with brisk knee and ankle jerks. Management and Outcome: Routine blood work was within the normal limits. Magnetic resonance imaging of the brain was suggestive of brainstem encephalitis. Cerebrospinal fluid analysis revealed albumin-cytological dissociation. Electroencephalography did not show epileptiform discharges. A diagnosis of BBE was made, although anti-Ganglioside Q1b antibody could not be evaluated. The patient improved with intravenous immunoglobulin, dexamethasone, and supportive care. Conclusion: This case highlights the importance of early recognition of the clinical triad of BBE and emphasizes the need for prompt management for successful recovery.