Ref Number = PITIKA-ASPR0007
Hario Widhi Nugroho, Kuntum Basitha, Ardhani Indra Puspita, Elvia Maryani, Eva Musdalifah, Isna Nurhayati
Seizure is one of the most common neurological complication of bacterial meningoencephalitis and is correlated with high mortality and morbidity. This case report describes epilepsy as the complication of acute bacterial meningoencephalitis in an eight-year-old boy.
An eight-year-old boy was admitted to emergency room with unconsciousness after ten minutes of seizure. Ten days before, he had high fever, dizziness, and cough. There was no history of seizure. Physical examination showed GCS E2V2M4, neck stiffness, spasticity, positive Kernig sign and Babinski. Thorax examination revealed bilateral rhonchi. The laboratory result showed elevated blood glucose of 154 mg/dL with negative result of anti-HSV. Cerebrospinal fluid analysis showed normal cell count with elevated PMN (37.5%) and glucose (90.8 mg/dL), also Gram-positive cocci arranged in rows were found. Head MSCT-Scan showed meningeal enhancement and chest X-Ray revealed pulmonary edema with bronchopneumonia. The patient was hospitalized for ten days.
Two days after being discharged, the patient came with generalized tonic-clonic seizure for 45 minutes and unconsciousness, without any previous symptoms. Physical examination revealed impaired consciousness and bilateral rhonchi. The laboratory result showed slight leukocytosis (13,700 cells/?L). After being treated in ICU, the patient was stabilized while EEG was performed. The result showed abnormality in parietooccipital lobes. During hospitalization, we treated the patient with cefotaxime, dexamethasone, phenobarbital, and symptomatic drugs. Until recently, there is no episode of seizure nor neurological deficits while the patient is treated with valproic acid and piracetam.
This case showed epilepsy as the complication following acute bacterial meningoencephalitis. Having seizure during acute infection is associated with the development of late seizures as the long term sequelae. Most of them occurs within five years after infection and could be recurrent. Epilepsy as the complication of bacterial meningoencephalitis needs long term management, including antiepileptic treatment and EEG evaluation.
Keywords: Seizure, meningoencephalitis, epilepsy, complication, antiepileptic drug
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