Affiliations: Department of Medicine, University College Hospital,
PMB 5116, Ibadan, Nigeria | Department of Radiology, University College Hospital,
PMB 5116, Ibadan, Nigeria | Department of Pediatrics, University College Hospital,
PMB 5116, Ibadan, Nigeria
Note: [] Correspondence: Mayowa Ojo Owolabi, MBBS, MWACP, FMCP
(Neurology), Lecturer and Consultant Neurologist, Department of Medicine,
University College Hospital, PMB 5116, Ibadan, 200001, Oyo State, Nigeria.
Tel.: +234 802 077 5595 and +234 28 707 916; E-mail: mayowaowolabi@yahoo.com
Abstract: Rasmussen's encephalitis (RE) is a rare disease of the brain
characterized by focal seizures, unilateral cortical deficits, hemiparesis, and
hemiatrophy of the contralateral cerebral hemisphere. The affected brain tissue
shows a chronic inflammatory histopathology and an autoimmune reaction is
suspected. Therapeutic strategies include anticonvulsants, immunomodulation and
surgery. We present the first report of RE in a Nigerian. A 4-year-old girl
presented with a 15-month history of recurrent involuntary jerky movements of
the right upper limb and tonic deviation of the neck to the right side often
associated with loss of consciousness. Seizures lasted 2 to 3 min and occurred
every 2 to 3 h. She later developed right-sided weakness. On examination, she
had right-sided spastic hemiparesis with astereognosis. The
electroencephalograph showed theta and delta waves on the left cerebral
hemisphere with epileptiform sharp and slow waves and phase reversal pattern.
Brain computerized tomogram showed left hemispheric hemiatrophy with
non-enhancing hypodense lesions in the left hemisphere. This was confirmed by
brain magnetic resonance imaging, which showed left cerebral atrophy with
associated left white matter hyperintensities on fluid-attenuated inversion
recovery sequences. There was no enhancement with gadolinium. She improved on
anticonvulsants. She fulfilled the European Consensus criteria for the
diagnosis of RE. Electroencephalography and magnetic resonance imaging are
important for the diagnosis of RE, a condition worth considering in patients
with focal seizures and unilateral neurological deficits.
