Epilepsy secondary to encephalitis due to Epstein Barr virus

Abstract

Case presentation. This case is about a 44 years old woman with a history of occipital headache, incoherent speech and confused thinking. She initially presented ten points on the Glasgow scale and left hemiparesis. Cranial CT scan reported cerebral edema with right thalamic hypodense lesion and progressive neurological deterioration. The electroencephalogram showed unilateral right hemispheric deceleration. The cerebrospinal fluid study showed hyperproteinuria and a predominantly lymphocyte count of 450 cells with preserved glycorrhachia, without the presence of bacteria. Treatment. was managed with invasive ventilatory support and antibiotic and antiviral treatment at meningeal doses, in addition to anticonvulsants. Control tomographic findings showed hydrocephalus; a Becker type ventricular shunt was placed. IgM serology was positive for Epstein Barr virus and the viral genome was identified in the cerebrospinal fluid by polymerase chain reaction test. The control brain tomography showed persistent ventriculomegaly and cerebral edema, which led to the diagnosis of encephalitis of viral etiology complicated by epilepsy secondary to a demyelinating structural lesion of the right cerebral hemisphere. Outcome. Therapeutic intervention with intravenous immunoglobulin was performed with improvement of the general condition, it was possible to remove the ventricular shunt and pulmonary ventilation ten and 19 days after admission, respectively. The patient is currently in physical therapy with persistence of left hemiparesis, gait disturbances, dysarthria, and controlled convulsive episodes during the last six months.