Bickerstaff Brainstem Encephalitis with a Decorticate-like Posture, Involuntary Movements, Impaired Visual Acuity, and Prolonged Motor Disability.
Kei Ishizuchi, Jun Sakai, Ryotaro Okochi et al.
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Case in brief
A Japanese patient with Bickerstaff brainstem encephalitis presented with a decorticate-like posture, involuntary movements, and impaired visual acuity—features that obscured the usual clinical picture. The patient progressed to coma and required intubation. Recognition of the typical BBE triad of consciousness disturbance, external ophthalmoplegia, and ataxia, together with other characteristic features, supported diagnosis. Recovery was complicated by prolonged weakness: the patient needed an orthosis to walk for 10 months.
What made this case unusual
The decorticate-like posture, involuntary movements, and impaired visual acuity were atypical features that could obscure BBE; coma and intubation were followed by prolonged motor disability.
Diagnostic / clinical pearl
When unusual neurological features complicate assessment, the typical BBE triad—consciousness disturbance, external ophthalmoplegia, and ataxia—can help support early diagnosis.
Why it matters
Coma or intubation in BBE may be followed by prolonged weakness, so recovery can require extended mobility support.