Atypical Presentation of Cerebral Palsy and Seizures: A Case Report on Rasmussen’s Encephalitis in an Adolescent

Abstract

Rasmussen's encephalitis is a rare neurological disease first described in 1958 that is characterized by medico-refractory seizures, focal unilateral cerebral inflammation, and deficits such as hemiparesis. While we still do not have a full understanding of this disease, proposed theories behind its etiology include autoimmune manifestations, immune attack by T cells, and malfunctional alterations in genetic expression. It is classically considered a rare childhood malady with a median age of onset of six years, and cases in adolescents and adults are even rarer, representing up to 10% of all cases to date. In this report, we would like to share a rare case of Rasmussen's encephalitis that occurred in an adolescent. Our 17-year-old male patient presented with signs and symptoms beginning at age 14 and was initially diagnosed with cerebral palsy only to later present with additional symptoms and characteristic EEG and MRI findings that ultimately led to a diagnosis of Rasmussen's encephalitis. Thus, with this case report, our intent is twofold: to shed light on an atypical presentation of an already rare disease, even rarer in adolescents and adults, and to underscore the importance of keeping a broad differential when it comes to evaluating a patient with seizures.

Atypical Rasmussen's Encephalitis

“…However, ER patients without or with delayed seizure onset have been published. There are four reports of atypical RE patients without seizures or delayed seizure onset [9][10][11][12]. In a retrospective study of 10 patients with atypical RE, the most frequent feature was progressive hemiparesis without seizure or late-onset events, followed by dyskinetic movements, late-onset seizures associated with unilateral caudate atrophy, image mimicking focal cortical dysplasia as the first MRI abnormality, and cluster epileptic spasms, only one patient remained without seizures [11].…”