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Peduncular Hallucinosis and Overlapping Antiganglioside Antibody Syndrome
American Journal of Psychiatry and Neuroscience
Volume 7, Issue 1, March 2019, Pages: 8-11
Received: Nov. 15, 2018; Accepted: Dec. 17, 2018; Published: May 27, 2019
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Alexis Demas, Department of Neurology, Hospital Jacques Monod, Le Havre, France
Guillaume Costentin, Department of Neurology, University Hospital Charles Nicolle, Rouen, France
Vincent Langlois, Department of Internal Medicine and Infectious Diseases, Hospital Jacques Monod, Le Havre, France
Yvan Vaschalde, Department of Neurology, Hospital Jacques Monod, Le Havre, France
Jean Philippe Cochin, Department of Neurology, Hospital Jacques Monod, Le Havre, France
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Guillain Barre Syndrome (GBS), Miller Fisher Syndrome (MFS) and Bickerstaff Brainstem Encephalitis (BBE) form part of the same disease spectrum, sharing some clinical signs and auto-immune based mechanisms with antiganglioside antibodies. GBS, the most common cause of subacute flaccid paralysis, is a well-known and extensively described syndrome. MFS is characterized by subacute ophthalmoplegia, ataxia and areflexia. In 1957, Bickerstaff described some patients who, in addition to ataxia and ophthalmoplegia, had abnormal mental status, corresponding to brainstem involvment. Neurological manifestations associated with anti-GQ1b antibodies can occur in isolation or in association. We report the case of a woman with an unusual psychiatric presentation (peduncular hallucinosis) of anti-GQ1b antibody syndrome, with features of these three diseases, and a dramatic improvement with immunoglobulin therapy. Peduncular hallucinosis are a rare form of visual hallucination. They are often described as colourful visions of people and animals, and are usually associated with vascular lesions in the midbrain and thalamus. This provides further evidence of the broad spectrum of neurological diseases associated with antiganglioside antibodies. To the best of our knowledge this is the first description of PH complicating BBE. Clinicians should be aware of the existence of overlapping syndrome with combined central and peripherical neurological system involvement.
Antiganglioside Antibodies Overlapping Syndromes, Guillain Barre, Miller Fisher, Bickerstaff's Brainstem Encephalitis, Peduncular Hallucinosis
To cite this article
Alexis Demas, Guillaume Costentin, Vincent Langlois, Yvan Vaschalde, Jean Philippe Cochin, Peduncular Hallucinosis and Overlapping Antiganglioside Antibody Syndrome, American Journal of Psychiatry and Neuroscience. Vol. 7, No. 1, 2019, pp. 8-11. doi: 10.11648/j.ajpn.20190701.12
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This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Goodfellow JA, Willison HJ. Guillain-Barré syndrome: a century of progress. Nat Rev Neurol. 2016 Dec; 12 (12): 723-731.
Bukhari S, Taboada J. A Case of Miller Fisher Syndrome and Literature Review. Cureus. 2017 Feb 22; 9 (2): e1048.
Kuwabara S, Misawa S, Mori M. Bickerstaff brainstem encephalitis: more common than we think? J Neurol Neurosurg Psychiatry. 2013 Nov; 84 (11): 1184.
Wakerley BR, Uncini A, Yuki N; GBS Classification Group.; GBS Classification Group. Guillain-Barré and Miller Fisher syndromes - new diagnostic classification. Nat Rev Neurol. 2014; 10 (9): 537-44.
Sekiguchi Y, Mori M, Misawa S, Sawai S, Yuki N, Beppu M, Kuwabara S. How often and when Fisher syndrome is overlapped by Guillain-Barré syndrome or Bickerstaff brainstem encephalitis? Eur J Neurol. 2016; (6): 1058-63.
Abrams JK, Johnson PL, Hollis JH, Lowry CA. Anatomic and functional topography of the dorsal raphe nucleus. Ann N Y Acad Sci. 2004; 1018: 46-57.
Alam A, Puri NV. Inefficacy of Antipsychotics in Treatment of Delirium and Agitation in Two Cases of Bickerstaff Brainstem Encephalitis. J Neuropsychiatry Clin Neurosci. 2014 1; 26 (2): 176–8.
Kölmel HW. Peduncular hallucinosis. J Neurol. 1991 Dec; 238 (8): 457-459.
Couse M, Wojtanoowicz T, Comeau S, Bota R. Peduncular hallucinosis associated with a pontine cavernoma. Ment Illn. 2018 May 16; 10 (1): 7586.
Manford M, Andermann F. Complex visual hallucinations. Clinical and neurobiological insights. Brain. 1998; 121 (Pt 10): 1819-1840.
Middleton FA, Strick PL. The temporal lobe is a target of output from the basal ganglia. Proc Natl Acad Sci USA. 1996; 93 (16): 8683-8687.
Masaaki Odaka, Nobuhiro Yuki, Mitsunori Yamada, Michiaki Koga, Toshihiko Takemi, Koichi Hirata, Satoshi Kuwabara, Bickerstaff’s brainstem encephalitis: clinical features of 62 cases and a subgroup associated with Guillain–Barré syndrome. Brain. 2003; 126 (10): 2279-2290.
Mondéjar RR, Santos JM, Villalba EF. MRI findings in a remitting-relapsing case of Bickerstaff encephalitis. Neuroradiology. 2002 May; 44 (5): 411-4.
Fukami Y, Wong AHY, Funakoshi K, Safri A y., Shahrizaila N, Yuki N. Anti-GQ1b antibody syndrome: anti-ganglioside complex reactivity determines clinical spectrum. Eur J Neurol. 2016 Feb 1; 23 (2): 320.
Stevenson V et al. Bickerstaff’s brainstem encephalitis, Miller Fisher syndrome and Guillain-Barre syndrome overlap with negative anti-GQ1b antibodies. Eur J Neurol. 2003 March 10 (2): 187.
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