Generalized Epilepsy with Right Hemiparesis Secondary to Herpes Encephalitis
Htay Lwin *
Family Medicine Unit, Department of Community Medicine, Melaka Manipal Medical College, Manipal Higher Academy of Education (MAHE), Malaysia.
Zay Yar Naing
Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman (UTAR), Kuala Lumpur, Malaysia.
Htoo Htoo Kyaw Soe
Department of Community Medicine, Melaka Manipal Medical College, Manipal Higher Academy of Education (MAHE), Malaysia.
Adinegara Lutfi Abas
Department of Community Medicine, Melaka Manipal Medical College, Manipal Higher Academy of Education (MAHE), Malaysia.
Soe Moe
Department of Community Medicine, Melaka Manipal Medical College, Manipal Higher Academy of Education (MAHE), Malaysia.
Mila Nu Nu Htay
Department of Community Medicine, Melaka Manipal Medical College, Manipal Higher Academy of Education (MAHE), Malaysia.
*Author to whom correspondence should be addressed.
Abstract
Herpes simplex encephalitis (HSE) is a medical emergency associated with high mortality and morbidity. Definitive diagnosis is established by history, clinical examination, neuroimaging studies, supportive electroencephalogram (EEG) findings, and cerebrospinal fluid (CSF) analysis.
A 7-year-old Malay girl with known case of right hemiplegia secondary to herpes encephalitis presented to the neuropediatric ward, in General Hospital with refractory seizure. She had a moderate learning disability and diagnosed as right hemiparesis secondary to herpes encephalitis complicated with epilepsy. She was planned for the positron emission tomography (PET) scan and to undergo operation if PET scan was feasible (Hemispherectomy). However, the patient refused for operation.
Prompt clinical recognition is important in the HSE to prevent progressive brain tissue damage, haemorrhagic changes, and worsening of the encephalitis. Diagnosis is usually confirmed through an extensive evaluation, including a thorough clinical examination with attention to findings on mental status changes, cerebrospinal fluid (CSF) analysis, electroencephalogram (EEG) testing and findings on neuroimaging.
Once HSE is suspected, high-dose acyclovir should be started immediately before lumbar puncture (LP), and only stopped once a definitive alternate diagnosis has been established.
This case is reported because the patient has generalized epilepsy with right hemiparesis secondary to herpes encephalitis. Herpes encephalitis with right hemiparesis cases are quite rare.
Keywords: Herpes Simplex Encephalitis (HSE), infection, epilepsy, right hemiplegia.