Case report: stroke-like onset of Bickerstaff brainstem encephalitis with Guillain–Barré syndrome

Introduction: Bickerstaff brainstem encephalitis is a rare immune-mediated disease characterized by ophthalmoplegia, ataxia, and disturbance of consciousness; it may overlap with Guillain–Barré syndrome if there is additional limb weakness [1] . These two diseases are considered to form a continuous clinical spectrum of the same disease, and may affect the peripheral and/or central nervous systems. They have monophasic symptoms and overlapping clinical signs, and their risk of recurrence is independent and very low [2] . Case Report: This paper describes a 79-year-old man with acute dysphagia and slurred speech; his symptoms rapidly progressed to include disturbance of consciousness and the progression of lower limb paralysis. The initial diagnosis was acute cerebral infarction; however, no new cerebral infarction lesions were identified in a series of brain magnetic resonance imaging examinations. Combined with the symptoms that appeared during hospitalization, the diagnosis was considered to be overlapping Bickerstaff brainstem encephalitis and Guillain–Barré syndrome. The patient’s symptoms improved after receiving treatment that included intravenous methylprednisolone. Conclusion: This case report expands the clinical scope of this disease and provides additional directions and decision-making strategies for cases that begin with acute stroke but are not supported by imaging.