Bickerstaff encephalitis and atypical features - Bickerstaff's papers revisited

摘要

We thank Dr Wong et al. for their interest in our paper regarding Bickerstaff brainstem encephalitis and value their description of the spectrum of presenting features of Bickerstaff encephalitis, thus further highlighting the importance of recognizing atypical presentations of rare disorders [1].Although dysarthria, dysphagia, ophthalmoplegia and diplopia, are uncommon in anti-NMDA receptor encephalitis these clinical features have been identified in some patients [2]. We agree with Dr Wong et al. that there remains considerable uncertainties concerning Bickerstaff brainstem encephalitis (BBE). Although it is theoretically possible that multiple auto-immune disorders and several antibodies may co-occur it would seem unlikely that both may clinically present concurrently. As BBE is frequently associated with an infectious trigger, while anti-NMDA encephalitis is commonly associated with a tumour (e.g. ovarian teratoma), the chance of co-incidental co-occurrence seems low