PROBABLE RASMUSSEN'S ENCEPHALITIS: CASE REPORT

SALVADOR DIAS VIEIRA NETO, VINICIUS NONATO DE OLIVEIRA, ELISABETE CASTELON KONKIEWITZ, BIANCA RIBEIRO MORAES

Resumo


Introduction: Rasmussen's encephalitis (RE) is characterized by the development of refractory epilepsy,
progressive hemiparesis, variable motor deficits, neurological deterioration and atrophy of one cerebral
hemisphere. The etiology is unknown yet, and the pathological abnormalities are variable.¹ The crisis
usually begins in childhood and are refractory to antiepileptic usual pharmacology and clinical treatments.
The best recommendation for treatment and seizures control is remove or disconnect the affected
cerebral hemisphere, in an operation called hemispherectomy. Material and Methods: This study was
conducted through clinical follow-up of a patient with several epileptic seizures. It was analyzed the
diagnostic investigation obtained by clinical examination, laboratory tests and complementary methods.
The data were obtained by medical record study between 01.23.2014 to 02.03.2014 and 02.06.2014 to
06.09.2014. Case Report: An 39-year-old woman diagnosed with epilepsy 30 years ago was admitted
(23/01) in the hospital because of erythematous maculopapular rash with intense itching in almost every
body area one month after initial use of Lamotrigine and Valproate. Physical examination showed lesions
in almost all body area and accompanied of edema. The mentioned medications were removed and the
pulse therapy with methylprednisolone for five days was initiated, therewith was verified improvement
of lesions and edema. On the first day of admission, the patient had an epileptic seizure and started the
use of new anticonvulsant medications (Phenytoin 100mg, 12/12 hrs and Topiramate 100mg, 12/12 hrs).
However, after clinical observation for 10 days she didn't show new epileptic seizures and with the
improvement of lesions and edema, the patient was discharged. In June 2014, the patient was
hospitalized again because of an episode of mental confusion with echolalia and stereotyped movements,
left hemiparesis and disconnected answers that started three days ago. It was also reported frequent
tonic-clonic epileptic seizures with daily attendance, repeating multiple times during the day. Preceding
the epileptic seizures, was reported scintillating scotoma few minutes earlier. On neurological exam was
observed painful and tactile hypoesthesia in left hemibody, without facial involvement. During
hospitalization there have been several seizures and psychomotor agitation requiring the realization of
diazepam (10 mg, IV). Furthermore, it was started the use of Oxcarbazepine (600mg - 12/12 hrs) as
additional therapy to maintenance treatment (Phenytoin 150mg, 8/8 hrs and Topiramate 100mg, 12/12
hrs). Based on the MRI images was found volumetric reduction of the right cerebral hemisphere, being
associated with hyperintense signal on T2 / FLAIR of the cortical and deep gray matter, including
compromising the hippocampus. Discussion and Conclusion: The reported case presents a patient with
the diagnosis of epilepsy 30 years ago and with several admissions during this period because of epileptic
seizures. However, through your clinical follow-up with recurrent seizures, resistance to certain antiepileptic drugs and MRI brain findings converges and suggests the diagnosis of Rasmussen's encephalitis.
Thereby, it was necessary clinical-surgical follow-up in a referred service for surgery (hemispherectomy). Thus, it is necessary the early diagnosis of RE to develop an effective treatment plan (drugs and mainly
surgery) and consequently slow down the progression of the disease.



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Referências


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