Etiology matters for neuroprognostication: A multimodal electrophysiological investigation in a case of Bickerstaff's brainstem encephalitis.

Abstract

We report the case of a 19-year-old patient with an acute-onset non-traumatic coma. Brain MRI scan was normal, CSF showed mild pleocytosis and moderately elevated protein, and continuous EEG-monitoring was compatible with spindle-coma. Cortical somatosensory evoked potentials (SSEPs) and middle-latency auditory evoked potentials (MLAEPs) were bilaterally absent, and brainstem auditory evoked potentials suggested a brainstem dysfunction. Serum anti-GQ1b and anti-GT1a IgG antibodies positivity suggested Bickerstaff's brainstem encephalitis (BBE). The clinical and functional outcomes were favorable and normal cortical SSEPs/MLAEPs reappeared in a few weeks. Based on this report, in cases of unexplained MRI-negative coma with neurophysiological evidence of brainstem dysfunction, BBE should be eliminated before considering withdrawal of life-sustaining therapy (WLST).

• Authors: Florent Cluse, Antoine Pegat, Thomas Ritzenthaler, Florent Gobert, Julien Jung
• Journal: Neurophysiologie clinique = Clinical neurophysiology (Neurophysiol Clin) Vol. 52 Issue 5 Pg. 398-403 (Oct 2022) ISSN: 1769-7131 [Electronic] France
• PMID: 36210256 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2022 Elsevier Masson SAS. All rights reserved.

Chemical References

• Gangliosides
• Immunoglobulin G

Topics

• Humans
• Young Adult
• Adult
• Gangliosides
• Coma (diagnosis, etiology)
• Encephalitis (diagnosis)
• Brain Diseases
• Brain Stem
• Immunoglobulin G