Rodica Cozac and Lilia Rotaru

ABSTRACT

In pediatric patients Epstein-Barr virus (EBV) infection may have miscellaneous neurological manifestations. Children with acute viral encephalopathy may present prolonged electrographic seizure activity consistent with nonconvulsive status epilepticus (NCSE). NCSE condition is difficult to diagnose due to absence of motor seizures, presenting only changes in behavior and consciousness. In this report we present a clinical case of EBV infection in 3.5-year-old girl. On admission she suffered of confusional state and irritability after an episode of motor partial complex seizure being in good health. The condition evolved twenty five days after an episode of respiratory infection diagnosed as bacterial tonsillitis by the family physician and treated with antibacterials. Laboratory blood evaluation as well as chest radiography, urinalysis, bleeding time, fibrinogen were within the normal range. Magnetic resonance imaging of the brain and spinal cord revealed a subcortical increased signal in the left occipital lobe on T2-weighted image. Electroencephalography (EEG) pattern revealed nonconvulsive status epilepticus (NCSE). EBV infection was revealed by serum antibody test. The present case emphasizes the importance to evaluate the role of EBV in acute neurological syndromes in pediatric patients, in particular, in presence of behavioral changes with EEG evidence of seizures. NCSE in children denotes electrographic seizures without convulsive activity and often manifests as altered mental status. It may be difficult to diagnose in pediatric patients in whom changes of behavior and consciousness may not be as easily recognized as in adults.

Keywords: epstein-Barr virus, nonconvulsive status epilepticus, pediatric neurology

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