Seizures in pediatric emergency and autoimmune encephalitis, an essential and challenging differential diagnosis: a case report

Case presentation: Three-years-old male attended with a generalized tonic-clonic seizure. No history of traumatic brain injury, fever or associated flu-like symptoms. Days before, aggressive behavior, slurred speech, visual hallucination. Only one previous seizure, month ago, without status epilepticus. Electroencephalogram (EEG): brush pattern extreme delta, cerebrospinal fluid (CSF) IgG+ for herpes and normal magnetic resonance. This condition corroborates the diagnosis autoimmune encephalitis, pulse therapy was instituted empirically. He also required anticonvulsant drugs improvement in epileptic seizures wakefulness. However, developed significant psychosis, agitation, extrapyramidal syndrome dystonia involuntary movement, antipsychotic drugs. Diagnosis confirmed positive CSF anti-N-methyl-D-aspartate receptor (anti-NMDAR). remained hospitalized 97 days, being discharged hypotonia limited to bed, severe encephalitic gastrostomy. Received eight cycles complete neurological condition.