Varicella-Zoster Virus Encephalitis Mimicking Acute Stroke: A Case Report
Abstract
Abstract Background Varicella zoster virus encephalitis (VZV), although rare, is commonly seen among the paediatric population and immunocompromised adults. It is often misdiagnosed due to its arsenal of myriad presentations mimicking other disease conditions. Late diagnosis with an attending delayed intervention often yields bad outcomes, with death being the most feared complication among affected individuals. In view of that, a high index of suspicion is imperative for early diagnosis and timely intervention. Case Presentation: We present a 16-year-old Ghanaian female of Akan ethnicity who presented with a 3-day history of recurrent generalized tonic-clonic seizures and confusion associated with right-sided weakness and persistent drooling, but no prior history of febrile illness, neck stiffness, headache, photophobia, or sick contact with chicken pox or herpes simplex infection. Glasgow Coma Scale (GCS) was 14/15 (Eye − 4, Verbal − 4, Motor − 6), pupils reacted equally to light, neck was supple with a right lateralizing sign; power was 1/5 in both upper and lower limbs and right plantar response was extensor. Other systemic examinations were unremarkable. All laboratory investigations, including brain MRI were normal. However, the CSF Viral panel RT-PCR was positive for Varicella zoster virus. Management and Outcome: A diagnosis of VZV encephalitis complicated by right hemiparesis was made. She was then treated with levetiracetam, acyclovir, dexamethasone, and…
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