Abstract Details

Title Super Refractory Status Epilepticus Secondary to La Crosse Virus Encephalitis: A Case Report

Topic Infectious Disease

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-032

Objective Encephalitis secondary to infection by the La Crosse virus is rare in the United States, with approximately 63 cases of neuroinvasive disease reported each year. It is most prevalent in the upper Midwest, mid-Atlantic, and southeastern United States. The primary vector of transmission is Aedes triseriatus, the eastern treehole mosquito.

Background We present the case of a previously healthy 50-year-old man who presented to the University of Minnesota Medical Center for evaluation of confusion, lethargy, amnesia, and personality changes.

Design/Methods The patient’s symptoms started approximately one week following a nondescript bug bite. Electroencephalography revealed non-convulsive status epilepticus. Initial efforts to control seizures with intravenous antiepileptic medications were unsuccessful and he was transferred to the neurocritical care unit for more aggressive management of refractory status epilepticus. Despite initiation of an anesthetic infusion, he developed super refractory status epilepticus. He remained on anesthetic drips for 42 days. Multiple medical complications arose, including acute respiratory distress syndrome, pulmonary embolism secondary to deep vein thrombosis, adynamic ileus, sepsis, critical illness myopathy, and pentobarbital toxicity. A total of 14 different medications were used to control his seizures with a maximum of eight being used simultaneously. Extensive infectious and autoimmune workups were largely unrevealing with the exception of a positive PCR for La Crosse virus in cerebrospinal fluid. On hospital day 54, he was discharged to a long-term care facility where his condition continued to improve.

Results Nearly 2 years since discharge, he remains on five antiepileptic medications with occasional complex partial seizures. There has been no recurrence of status epilepticus. He is generally doing well, but has ongoing cognitive deficits with impaired executive functioning.

Conclusions This case illustrates the significant neurologic complications associated with La Crosse virus encephalitis and highlights the value of aggressive supportive care in a well-equipped neurocritical care unit.

Authors/Disclosures
Leighton Mohl, MD PRESENTER	Dr. Mohl has nothing to disclose.
Benjamin R. Miller, MD (University of Minnesota)	The institution of Dr. Miller has received research support from StrokeNET.

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