MRI Evolution of a Patient with Viral Tick-Borne Encephalitis and Polymorphic Seizures

Some neurotropic viruses induce specific lesions in the deep structures, such as basal ganglia and thalamus. These anatomical structures play an important role in initiating and maintaining different types of epileptic seizures. We present the case of a 25-year-old male, transferred to our clinic one week after the onset of the symptomatology, with a recent history of traveling to Turkey and Egypt. At the moment of his hospital admission, his symptoms included altered consciousness, agitation, and seizures. Shortly after, his state worsened, requiring intubation. Viral tick-borne encephalitis diagnoses were favored by the CSF (cerebrospinal fluid) analysis, EEG (Electroencephalography), MRI (magnetic resonance imaging) images presenting symmetric hyper signal in the basal ganglia, and IgM antibodies for anti-tick-borne encephalitis. These lesions persisted for several weeks, and the patient's seizures were polymorphic, originally generalized onset motor, generalized onset non-motor, and focal myoclonic. The patient achieved his independence, seizures decreasing both in intensity and frequency; the MRI images became almost normal. The reduction in antiepileptic doses was not followed by seizure recurrence.

Automated summary

Some neurotropic viruses can cause specific lesions in deep structures, such as the basal ganglia and thalamus, leading to different types of epileptic seizures. This case report describes a 25-year-old male who presented with altered consciousness, agitation, and seizures after traveling to Turkey and Egypt. The diagnosis of tick-borne encephalitis was supported by cerebrospinal fluid analysis, electroencephalography, magnetic resonance imaging showing hyper signal in the basal ganglia, and IgM antibodies. The patient's seizures improved over time and the MRI images returned to almost normal, without seizure recurrence after reducing antiepileptic doses.