Title: Seizures in pediatric emergency and autoimmune encephalitis, an essential and challenging differential diagnosis: a case report
Abstract: Case presentation: Three-years-old male attended with a generalized tonic-clonic seizure. No history of traumatic brain injury, fever or associated flu-like symptoms. Days before, aggressive behavior, slurred speech, visual hallucination. Only one previous tonic-clonic seizure, one month ago, without status epilepticus. Electroencephalogram (EEG): brush pattern extreme delta, cerebrospinal fluid (CSF) with IgG+ for herpes and normal brain magnetic resonance. This condition corroborates the diagnosis of autoimmune encephalitis, and pulse therapy was instituted empirically. He also required anticonvulsant drugs with improvement in epileptic seizures and wakefulness. However, also developed significant psychosis, agitation, extrapyramidal syndrome with dystonia and involuntary movement, and also required antipsychotic drugs. Diagnosis was confirmed with positive CSF for anti-N-methyl-D-aspartate receptor (anti-NMDAR). He remained hospitalized for 97 days, being discharged with hypotonia limited to bed, severe encephalitic condition and gastrostomy. Received eight pulse therapy cycles with complete improvement of neurological condition.