Open AccessBilateral independent periodic lateralised epileptiform discharges at presentation followed by rapid recovery: novel observations from a case of Epstein-Barr virus encephalitis
Author(s) -
Rajesh Shankar Iyer,
Ramakrishnan Tirupur Chinnappan Ramalingam,
Saleem Akhtar,
Shabeer Ponnadan
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-229879
Subject(s) - encephalitis , electroencephalography , medicine , coma (optics) , encephalopathy , neurology , herpes simplex virus , presentation (obstetrics) , virus , pathology , pediatrics , anesthesia , virology , psychiatry , surgery , physics , optics
Bilateral independent periodic lateralised epileptiform discharges (BIPLEDs) in electroencephalograms (EEGs) are commonly caused by anoxic encephalopathy and central nervous system infections. They are associated with coma and high mortality and are thus markers of poor prognosis. We present a case of encephalitis who presented with BIPLEDs in EEG. Though the clinical, EEG and MRI features closely resembled herpes simplex encephalitis, further investigations proved it to be Epstein-Barr virus (EBV) encephalitis. Despite the presence of BIPLEDs in the EEG, the patient had a rapid clinical response to therapy with acyclovir. We emphasise that BIPLEDs may not always indicate poor prognosis especially in the setting of EBV encephalitis.