Bickerstaff brainstem encephalitis associated with Chikungunya infection: A case report

Abstract

Introduction: Bickerstaff brainstem encephalitis is a rare autoimmune disease that presents certain similarities with other demyelinating neuropathies. The classic diagnostic triad includes ophthalmoplegia, ataxia and/or pyramidal symptoms. The global prevalence is unknown, and it is associated with an immune reaction triggered by a viral or bacterial infection or recent immunization. Clinical case: The case of a 57-year-old female patient with a four-week history of Chikungunya is presented. Current three-day history of weakness in the lower and upper extremities, tingling sensation in the lower extremities, left facial paralysis, ocular deviation, and right lateralized corner of the mouth. Neurological examination: conscious, left peripheral facial paralysis, bilateral facial hypoesthesia, dysarthria, difficulty smiling, blowing, whistling and swallowing, paresis of eye movements, bilateral eyelid ptosis, decreased visual acuity, bilateral blurred vision, diplopia, limbs with weakness and lower limb paresthesia; involuntary and uncoordinated rigid movements, tendon areflexia. Magnetic resonance: punctate or amorphous cortico-subcortical hyperdensities. IgM and IgG antibodies were positive for Chikungunya. Treatment with methylprednisolone and complete remission at four months of follow-up. Conclusion: Although etiology is still under discussion, Bickerstaff brainstem encephalitis has been most frequently associated with viral infections, including arboviruses. It must be differentiated by its similarities with Guillain Barré or Miller Fisher syndrome.