Varicella zoster virus encephalitis mimicking acute stroke: a case report

Varicella zoster virus encephalitis (VZV), although rare, is commonly seen among the pediatric population and immunocompromised adults. It is often misdiagnosed due to its varied 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. 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, and neck was supple with right-sided weakness; 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 except CSF glucose concentrated which was elevated. However, the CSF viral panel RT-PCR was positive for Varicella zoster virus. A diagnosis of VZV encephalitis complicated by right hemiparesis was made. She was then treated with levetiracetam, acyclovir, dexamethasone, and paracetamol, resulting in complete resolution of her signs and symptoms by day 10 on admission . Viral encephalitis should be considered in patients presenting with vague neurological symptoms, with no focus, especially in low-resourced areas where PCR is unavailable. Rapid recognition and prompt treatment with antiviral agents can lead to complete recovery even in patients with protracted disease, ameliorating the debilitating complications associated with VZV encephalitis, thereby reducing mortality and morbidity.