D’Alessandro V, Muscarella LA, Copetti M, Zelante L, Carella M, Vendemiale G. Herpes simplex virus type 2 rarely involves the brainstem. Nakajima H,Furutama D,Kimura F,et al.Herpes simplex virus type 2 infections presenting as brainstem encephalitis and recurrent myelitis.Intern Med,1995,34:839-842. The extent of CNS demyelination is less in the immune-deficient athymic mice 7 days after infection compared to the immune-competent Balb/c mice. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report. Case 1 A 45-year-old lady, a known case of rheumatoid arthritis, on methotrexate and steroids since 6 years, developed abnormal behavior, followed by left side hemiparesis, fever and unconsciousness, a day prior to reporting. Brain MRI showed right side dominant, bilateral pontine segmental lesions extending slightly to the midbrain and medulla.
Routine investigations and screening for infections, vasculitis, SLE, HIV was negative. On day 3, he could no longer walk and vomited several times. In response to IV methylprednisolone, she steadily ________________________________ Corresponding author Mohamed Nagib Abdalla Idris, Department of Medicine, University of Khartoum, Sudan Email: email@example.com 98 Sudan Med J 2010;46(3) had improved to go back to work; serial brain MRI scans showed complete resolution of the lesions. Our final diagnosis was Bickerstaff brainstem encephalitis following malaria. Keywords: Bickerstaff’s brainstem encephalitis, malaria, corticosteroids, Sudan Introduction In 1951, Bickerstaff and Cloake described three cases of ophthalmoplegia under the title of “mesencephalitis and rhomboencephalitis” and suggested that the clinical features were due to a midbrain disturbance (1) . On arrival at hospital he was febrile, confused and slightly dysarthric but there were no signs of meningism. Here, we describe a patient with overlapping GBS and BBE associated with EBV who recovered completely without relapse by treatment with a combination of immunoglobulin (Ig) and methylprednisolone as well as acyclovir.
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