Background: Bickerstaff brainstem encephalitis (BBE) is an autoimmune disease characterized by impaired consciousness, ophthalmoplegia, and ataxia. We report two cases of BBE following COVID-19.
Case presentation: Case 1: A 51-year-old male was diagnosed with COVID-19 4 days after fever. He had prolonged loss of consciousness, and developed ophthalmoplegia and ataxia. He was treated with steroids and immunoglobulin, which improved his consciousness. Case 2: A 28-year-old female was diagnosed with COVID-19 because of fever 4 days after contact with a COVID-19 patient. She suffered from prolonged loss of consciousness, ophthalmoplegia, and myoclonus. She was treated with steroids, immunoglobulin, and plasmapheresis, which ameliorated her consciousness.
Conclusion: Both patients developed central nervous system (CNS) symptoms within a week of COVID-19 onset, indicating that BBE develops immediately after prior infection. This disease should be considered if CNS symptoms appear rapidly after COVID-19.
Keywords: autoimmune disease; central nervous system symptoms; early diagnosis; prior infection.
© 2025 The Author(s). Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.