Case Report: Takotsubo Cardiomyopathy in Bickerstaff Brainstem Encephalitis Triggered by COVID-19

Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy triggered by critical illness including severe neurological disorders. However, an association between TCM and Bickerstaff brainstem encephalitis (BBE) has rarely been described. During the current coronavirus disease 2019 (COVID-19) pandemic, growing evidence indicates that COVID-19 often leads to various neurological disorders, but there are few reports of an association between COVID-19 and BBE. Here we report a case of TCM associated with BBE triggered by COVID-19, which subsided with immunotherapy for BBE. Both transthoracic echocardiography and electrocardiography led to early and accurate diagnosis of TCM. Sustained hemodynamic instability due to TCM was immediately lessened with immunotherapy whereas additional plasmapheresis and immunotherapy were required to treat BBE. This case indicates that BBE might follow COVID-19 and TCM should be considered when hemodynamic status remains unstable in a patient with BBE.

Autoimmune Brainstem Encephalitis: An Illustrative Case and a Review of the Literature

Autoimmune brainstem encephalitis (BSE) is a rare neurological condition with a wide range of underlying etiologies. It can be subdivided into two broad groups: a primary inflammatory disease of the central nervous system (CNS) or a brainstem disorder secondary to systemic diseases where the CNS is only one of many affected organs. Symptoms range from mild to life-threatening manifestations. Most cases respond well to immunotherapy. Therefore, broad and in-depth knowledge of the various inflammatory disorders that target the brainstem is essential for guiding the diagnostic approach and assisting in early initiation of appropriate therapy. We herein report on a case of BSE and provide an overview of the various causes of autoimmune BSE with an emphasis on the clinical manifestations and diagnostic approach.

Advanced Magnetic Resonance Imaging (MRI) Characterization in Bickerstaff's Brainstem Encephalitis

Purpose Bickerstaff's brainstem encephalitis(BBE) is considered a scarce variant of Miller-Fisher syndrome(MFS) and Guillain–Barré syndrome (GBS) but accounts for a significant proportion of brainstem encephalitis.Detailed knowledge of their neuroimaging manifestations is of paramount importance for a correct early diagnosis and proper management of the affected patients.In this study,We sought to characterize neuroimaging findings,including the morphology and manifestation of advanced MR imaging and differential diagnosis.Methods Seven BBE patients (5 males,2 females; mean age 42.5 ± 5.7 years,range 17 to 63 years) were retrospectively studied using conventional MRI (T1- and T2- weighted,FLAIR sequences,postcontrast T1-weighted images) and advanced MRI such as diffusion-weighted imaging (DWI) and proton magnetic resonance spectroscopy (MRS).The apparent diffusion coefficient (ADC) values and the MRS ratio were calculated in lesion regions.Results1. The distribution of these lesions typically include bilateral and symmetrical involvement of the mesencephalon,thalamus,tegmentum,infratentorial periaqueductal region,and the periventricular region surrounding the third and fourth ventricles involving white and gray matter; additional supratentorial white matter is not involved.2. MRI axial T2-weighted images and FLAIR sequences showed nearly symmetrical hyperintense signal changes with slightly spotty,patchy,or confluent homogeneous enhancement on postcontrast T1-weighted images without necrosis or hemorrhage.3. DWI signal was enhanced,and the apparent diffusion coefficient (ADC) map signal was slightly increased.ADC values of BBE lesions were in the range of 1.21 to 1.67 × 10−3 mm/s2 (mean 1.38 ± 0.66 × 10−3 mm/s2).4. Proton MR spectrum showed a slight increase in choline and a relative decrease in NAA peak,while Lipid and Lac doublet were not detected.Conclusion Advanced MRI imaging can provide important physiological and metabolic information of BBE and complement the morphological findings of the clinical conventional MRI.

Distinguishing Spastic and Dystonic Features in a Patient With a History of Brainstem Encephalitis: A Clinical Case Study

Purpose One role of a speech-language pathologist (SLP) is to differentially diagnose motor speech disorders to aid physicians, typically neurologists, in establishing a medical diagnosis. The present case study describes the clinical problem solving undertaken by the SLP to characterize the nature of neurological deficits to develop an appropriate management plan. Method The patient is a 29-year-old man with a history of brainstem encephalitis who presented for evaluation of dysarthria, dysphagia, and gait difficulties. The neurological exam characterized a spastic dysarthria. The SLP conducted a motor speech examination expressly for the purpose of differential diagnosis. Results The patient exhibited features of spastic dysarthria including strained phonation and hypernasality, equivocally slow rate associated with intermittent interword pauses rather than lengthened segments, and articulatory imprecision in the absence of weakness or slowness of the articulators. Defining features of spastic dysarthria absent from his speech were monopitch and monoloudness, as well as slow alternate motion rates. A diagnosis of hyperkinetic dysarthria associated with dystonia was informed by (a) hypernasality disproportionate to other deviant speech features, with preserved reflexive velar movements and nonspeech movements; (b) adventitious lip pursing; (c) modest improvement in speech with sensory tricks; (d) mild and intermittent phonatory strain; and (e) normal nonspeech oral motor function. Conclusions This case demonstrates the role speech-language pathology can play in the neurological assessment and management process. The recognition by the SLP of hyperkinetic dysarthria led to additional diagnostic tests and to a broader range of options for medical management.

First report of Bickerstaff’s brainstem encephalitis caused by Salmonella Dublin: a case report

Background Diseases caused by nontyphoid Salmonella can range from mild, to self-limiting gastroenteritis and severe invasive infection. Relatively rarely, Salmonella may cause severe encephalopathy. Case presentation We report a suspected case of Bickerstaff’s brainstem encephalitis caused by Salmonella Dublin. A young man presented with impaired consciousness, ataxia, dysarthria, limb weakness, and restricted eyeball abduction. His clinical symptoms were consistent with Bickerstaff’s brainstem encephalitis. Conclusions This is the first case report of Bickerstaff’s brainstem encephalitis caused by Salmonella Dublin in the literature. After treatment, he recovered and was discharged. Early antibiotic treatment of sepsis may control the disease and avoid serious encephalopathy.