Abstract Details

Title Post-infectious CNS Vasculitis Presenting With Stroke, New Onset Status Epilepticus, and Reversible Locked-in Syndrome

Topic Neuro Trauma and Critical Care

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 19-009

Objective To describe a rare case of post-infectious CNS vasculitis presenting as acute ischemic stroke, new-onset status epilepticus, and locked-in syndrome which showed remarkable recovery after immunomodulatory therapy.

Background CNS vasculitis is an uncommon but potentially reversible cause of neurologic injury with varied presentations. The simultaneous occurrence of acute ischemic stroke and new-onset status epilepticus is infrequent. Early recognition and treatment are essential for recovery.

Design/Methods Single-patient case report summarizing clinical presentation, diagnostic evaluation, and therapeutic response.

Results A 48-year-old female with no vascular risk factors and a flu-like illness two weeks prior presented as a stroke alert with acute aphasia and new-onset status epilepticus. CT angiography showed short-segment basilar artery stenosis, and she received intravenous thrombolysis for presumed ischemic stroke. Despite eventual seizure control with levetiracetam, lacosamide, and midazolam infusion, she remained ventilator-dependent and with clinical locked-in syndrome with preserved awareness. MRI revealed bilateral pontine and right parietal infarcts with petechial hemorrhages. Cerebrospinal fluid showed markedly elevated protein with negative infectious and autoimmune panels, prompting initiation of high-dose corticosteroids. Digital subtraction angiography confirmed multifocal narrowing and distal vessel “beading” consistent with CNS vasculitis. Five sessions of plasmapheresis led to successful extubation, marked neurologic improvement (all extremities at least 3/5 in strength by discharge), and near-complete resolution of arterial vessel changes in follow-up studies.

Conclusions This case illustrates a rare manifestation of post-infectious CNS vasculitis presenting with new onset status epilepticus and multifocal ischemic strokes in a previously healthy patient without traditional vascular risk factors. Maintaining a high index of suspicion and initiating early immunomodulatory therapy can enable meaningful recovery, even in severe presentations resembling locked-in syndrome.

Authors/Disclosures
Poojitha Koppu, MD PRESENTER	Poojitha Koppu has nothing to disclose.
Belinda Philip, MD	Dr. Philip has nothing to disclose.
Zemen Abu, MD (Broward Health North Neurology department)	Dr. Abu has nothing to disclose.
Danisette Torres, MD (Florida Atlantic University)	Dr. Torres has nothing to disclose.

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