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An Autopsy Case of Brain Stem Encephalitis with Spinal Cord Involvement

An autopsy case was presented of brain stem encephalitis diagnosed clinically. A patient was taken ill with headache and double vision. He developed character change, dysphagia, dysarthria, nuchal rigidity and spastic quadriparesis with intermittent fever, following the disappearance of double vision. These symptoms and signs progressed slowly with transient remissions. He died at the age of thirty‐five years, three years and six months after the onset. On neuropathological examination, there were chronic inflammatory lesions together with demyelination and gliosis in the hypothalamus, lower end of the internal capsule, optic chiasm, midbrain, pons, medulla oblongata and spinal cord. The clinicopathological features of our case were most similar to those of brain stem encephalitis described by Iizuka. However, the spinal cord involvement was severe in our case. Viral studies examined were all negative, despite that the neuropathological findings were suggestive of some viral infection.