Rasmussen encephalitis

Case contributed by Mustafa Takesh
Diagnosis almost certain

Presentation

Imbalance

Patient Data

Age: 4 years
Gender: Male
ct

Selected CT images showing prominence of peripheral CSF-spaces over the left cerebral hemisphere, in particular over the temporal and parietal lobes, with slight enlargement of the ipsilateral lateral ventricle.

MRI 10 years later

mri

Selected MRI images demonstrating left cerebral volume loss, sparing the occipital lobe with ex vacuo dilatation of the left lateral ventricle.

Case Discussion

This patient presented initially with imbalance and then developed to hemiparesis. The diagnosis of Rasmussen’s encephalitis was proven by biopsy of left temporal lobe.

Rasmussen’s encephalitis is a rare unilateral T-cell mediated chronic inflammation in the cerebral cortex, of unknown origin, but likely via autoimmune response. This leads to progressive hemispheric atrophy. 

The most common symptom is medically refractory seizure. This case shows the importance of considering Rasmussen’s encephalitis among the differential diagnosis, even if the classic symptom (seizure) is lacking,

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