Acute encephalopathy with biphasic seizures and late restricted diffusion temporally associated with human bocavirus infection

Abstract

Acute encephalitis is a syndromic diagnosis. In the last two decades, a unique clinico-radiological entity, named acute encephalopathy with biphasic seizures and late restricted diffusion (AESD), has been reported in children from Asia. It is characterised by an acute febrile illness with seizures and encephalopathy, with some initial improvement followed by a second flurry of seizures and deep encephalopathy, 3–4 days later. MRI may show a pattern of ‘bright tree appearance’. An aetiological agent may not always be identified but an infectious trigger is proposed. Immunomodulatory therapy has been tried with variable results. The prognosis is variable, and children are usually left with neurological sequelae including epilepsy and cognitive impairment. We describe a female infant who presented with the typical clinico-radiological syndrome of AESD and human bocavirus was identified in the stool. She received steroids and antiepileptic drugs. She has persistent cognitive impairment at follow-up but remained seizure free.

SARS-CoV-2-Related Pediatric Encephalopathy with Biphasic Convulsions and Cortical Blindness: A Case Report

“…10 Another case of AESD caused by bocavirus with visual disturbance was also reported; however, after 2 months of observation, the visual acuity did not improve. 11 AESD is often reported to have high signal in the frontal and parietal lobes on MRI, 12 but in this case and in these other reports, the BTA was also distributed in the occipital lobe, and the high signal on DWI was found not only in the subcortical white matter characteristic of AESD but also in the cortex contiguous with them, suggesting that the cortical blindness was caused by an injury to the visual pathway in the same region. Cortical blindness can manifest as Anton's syndrome, 13 in which the patient is unaware that he or she is blind despite visual impairment, and when the encephalopathy is severe, it can be difficult to determine if the patient is blind.…”

Human Bocavirus in Childhood: A True Respiratory Pathogen or a “Passenger” Virus? A Comprehensive Review

“…Unfrequently, the central nervous system is affected in children with HBoV infections with symptoms including seizures, encephalitis, and encephalopathy [ 78 , 79 , 80 , 81 ]. Guillain–Barré syndrome has been reported in a case of coronavirus co-infection [ 5 ], and a case of acute encephalopathy with biphasic seizures and late restricted diffusion associated with HBoV infection has been recently described in a female infant [ 82 ].…”