Generalized Epilepsy with Right Hemiparesis Secondary to Herpes Encephalitis

Main Article Content

Htay Lwin
Zay Yar Naing
Htoo Htoo Kyaw Soe
Adinegara Lutfi Abas
Soe Moe
Mila Nu Nu Htay

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.

Article Details

How to Cite
Lwin, H., Naing, Z. Y., Soe, H. H. K., Abas, A. L., Moe, S., & Htay, M. N. N. (2020). Generalized Epilepsy with Right Hemiparesis Secondary to Herpes Encephalitis. International Journal of Medical and Pharmaceutical Case Reports, 13(2), 9-13. https://doi.org/10.9734/ijmpcr/2020/v13i230116
Section
Case Report

References

Sili U, Kaya A, Mert A, et al. Herpes simplex virus encephalitis: clinical manifestations, diagnosis and outcome in 106 adult patients. J Clin Virol. 2014;60:112–118.

Bulakbasi N, Kocaoglu M. Central nervous system infections of herpesvirus family. Neuroimaging Clin N Am. 2008;18:53–84.

Pirasath S, Selvaratnam G, Pradeepan J. Herpes simplex encephalitis mimicking as cerebral infarction. J Clin Case Rep. 2016;6:877.

AbdulJabbar M, Ghozi I, Haq A, Korner H. Sudden 'stroke-like' onset of hemiparesis due to herpetic encephalitis. Can J Neurol Sci. 1995;22:320–321.

Goldstein MA, Harden CL. Infectious states. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co- existing disorders. Boston: Butterworth-Heinemann. 2002;83-133.

Epilepsy Foundation. Epilepsy as a consequence of infection. Available:https://www.epilepsy.com/learn/professionals/co-existing-disorders/infectious-statesseizures/epilepsy-consequence-infection

Kaddumukasa M, Kaddumukasa M, Matovu S, Katabira E. The frequency and precipitating factors for breakthrough seizures among patients with epilepsy in Uganda. BMC Neurology. 2013;13(1):1–7. DOI: https://10.1186/1471-2377-13-182

Al-Kattan M, Afifi L, Shamloul R, Mostafa EED. Assessment of precipitating factors of breakthrough seizures in epileptic patients. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2015; 52(3):165. Available:https://10.4103/1110-1083.162002

Bonnett LJ, Powell GA, Tudur Smith C, Marson AG (2017) Breakthrough seizures— Further analysis of the Standard versus New Antiepileptic Drugs (SANAD) study. PLoS ONE 2017;12(12): e019003512. Available:https://10.1371/journal. pone.0190035

Kwan P, Arzimanoglou A, Bert AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc task force of the ILAE commission on therapeutic strategies. Epilepsia. 2010;51: 1069–1077. Available:https://10.1111/j.1528-1167.2009.02397

Boshuisen K, Van Schooneveld MM, Uiterwaal CS, et al. Intelligence quotient improves after antiepileptic drug withdrawal following paediatric epilepsy surgery. Ann Neurol. 2015;78:104–114. DOI: https://10.1002/ana.24427

Kees PJ, Braun J. Helen Cross. Pediatric epilepsy surgery: The earlier the better, Expert Review of Neurotherapeutics. 2018;18(4)261-263. Available:https://10.1080/14737175.2018.1455503