Treatment of Bickerstaff's brainstem encephalitis with immune globulin

Bickerstaff's brainstem encephalitis (BBE) is an immune disorder of unknown etiology. Previous reports of successful treatment of BBE involved steroid s or plasma exchange. We describe a patient with BBE who demonstrated rapid clinical recovery after treatment with intravenous immune globulin. Our fi ndings suggest that IVIg is an alternative treatment in BBB, especially whe n plasma exchange is difficult or contraindicated. Our patient also demonst rated pseudoretraction and pseudoptosis during clinical recovery, an observ ation which supports a differential immune attack on components of the thir d nerve or supranuclear regions, and expands our understanding of the patho physiology of BBE. (C) 2000 Elsevier Science B.V. AII rights reserved.