Infant with right hemiplegia due to acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) A case report

Rationale: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a condition characterized by biphasic convulsions and disturbance of consciousness. In Japan, the most common pediatric cases of acute encephalopathy are associated with infection. AESD usually occurs in early childhood, with the characteristic magnetic resonance imaging (MRI) appearance called "bright tree appearance." The disease often has neurological sequelae and interferes with the schooling of children and their activities of daily living; however, there are few clinical case reports of hemiplegia caused by AESD. Patient concerns: A case with right-sided hemiplegia due to AESD in an 11-month-old girl who was followed up to 30 mo of age. Diagnoses: The patient was diagnosed with overlap AESD and hemiconvulsion-hemiplegia-epilepsy syndrome (HHE syndrome), based on the clinical course and imaging findings. DNA tests of her blood and cerebrospinal fluid revealed the presence of human herpesvirus 6. Interventions: Pharmacotherapy and rehabilitation therapy. Outcome: Gross motor function has recovered considerably, but she had a mild developmental delay at 30 mo old. Lessons: Hemiplegia due to AESD was extremely rare, and appropriate rehabilitation treatment resulted in recovery of physical function. However, as mild developmental delay was observed, the patient was referred to a specialized facility before entering school.