Overlapping Guillain-Barre syndrome and Bickerstaff's brainstem encephalitis associated with anti-GQ1b IgG antibody after herpes simplex virus infection

Herpes simplex virus (HSV) is a rare, antecedent infectious agent in Guilla in-Barre syndrome (GBS). We report a patient with overlapping GBS and Bicke rstaff's brainstem encephalitis (BBE). The patient had a vesicular lesion o n her nose. Antecedent HSV type 1 (HSV-1) infection was confirmed by isolat ion of the virus and detection of the presence of serum anti-HSV-1 IgM anti body during the acute phase. Her serum IgG had high anti-GQ1b antibody tite r. External ophthalmoplegia has been noted in 2 of 4 reported cases of HSV- associated GBS. Herpetic brainstem encephalitis cases of poor prognosis are known, but only 2 cases of benign brainstem encephalitis secondary to HSV infection, in which there was acute ophthalmoplegia and clinical features c onsistent with those of BBE have been reported.