Rare case of Rasmussen’s encephalitis in Ethiopia: a case report

Rasmussen’s encephalitis (RE) is an uncommon chronic neurological condition that presents with gradual neurological and cognitive impairment caused by a unilateral inflammation of the cerebral cortex. The case highlights the occurrence of Rasmussen’s encephalitis in a setting with limited resources, where advanced diagnostic modalities and specialized neurological care are limited, which leads to a longer disease process before the disease is diagnosed. A 24-year-old female Ethiopian descent presented to the neurology outpatient department with abnormal body movement of five days duration. She began complaining about strange bodily movements, hallucinations, delusions, and occasional left-side extremity weakness when she was nine years old. Brain magnetic resonance imaging showed diffuse right hemi cerebral (nearly all lobes) cortical and subcortical swelling with T2 and FLAIR hyper-intense signal change and patchy moderate restricted diffusion, slight asymmetrical effacement of the right lateral ventricle. Electroencephalogram showed right hemispheric lateralized periodic discharges. She was started on Tegretol 200 and 400 mg at day and night, respectively, Prednisone 40 mg, Dexamethasone 4 mg, and Pantoprazole 40 mg per day and had shown improvement in left side extremity weakness and abnormal body movement. Rasmussen’s encephalitis is a rare cause of seizures with unilateral cortical involvement. It can present with a long remission period like our case. Early immunomodulatory therapy improves the prognosis and slows down the disease progression.