An Unusual Case of Encephalitis with Starry Sky Pattern in MRI

Excerpt

A 5-y-old boy from rural Bengal presented with headache, vomiting, subtle changes in behavior and personality for 2 mo and one episode of generalized seizure. There was no family history of epilepsy or tuberculosis. On examination, he was conscious and confused. He had positive meningeal signs, increased tone and exaggerated reflexes, but no cranial nerve involvement or focal neurodeficit. Subcutaneous tissue, skeletal muscle, lungs or liver were not involved. His total count was 7,800/cmm with N64E10B00L24M02, platelet count was 362,000/cmm. Liver function tests, urea, creatinine, serum electrolytes and blood sugar were normal. Cerebrospinal fluid showed 130 cells, mainly lymphocytes and mildly raised protein (108 mg/dl), sugar (73 mg/dl) and chloride were normal. MRI showed a starry sky pattern with extensive tiny cystic lesions with eccentric nodules in bilateral cerebral hemispheres, brainstem and cerebellum (Fig. 1). Fundus examination revealed bilateral optic disc edema and exudative retinal detachment in left eye. Ultrasound scan suggested subretinal cysticercosis of the left eye. Thus a diagnosis of cysticercal encephalitis was made. Cysticidal treatment was withheld because of encephalitis and ocular involvement. He was treated with prednisolone and phenytoin, and was referred for vitrectomy.

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