[Guillain-Barré syndrome associated with external ophthalmoplegia, consciousness disturbance, and extensor plantar responses: an overlap between Guillain-Barré syndrome and Bickerstaff's brainstem encephalitis].

A 14-year-old girl developed diplopia and ataxic gait following upper respiratory tract infection. On day 3, she became lethergic, but was easily roused on stimulation. Neurologic examinations showed external ophthalmoplegia, tetraplegia, tendon areflexia, and extensor plantar responses. CSF protein was 93 mg/dl with normal cellurality on day 25. Serum in the acute phase of her illness had autoantibodies to gangliosides GQ1b and Ga1NAc-GD1a. An EEG showed bilateral theta activity. Results of ABR, SEP and blink reflexes suggested the presence of intramedullary brainstem lesion. She received plasmapheresis on days 4, 5 and 6. Neurological signs immediately improved. Five months after onset of neurological symptoms, she had no neurological abnormalities except for tendon areflexia. Electrophysiologic studies returned to normal concurrently with her clinical improvement. This patient demonstrates an overlap between Guillain-Barré syndrome and Bickerstaff's brainstem encephalitis.