Neuropsychiatric Sequelae of Japanese encephalitis (JE)

• Japanese encephalitis (JE) is an infection of the brain caused by the Japanese encephalitis virus (JEV) which is spread by mosquitoes. • JEV is the main cause of viral encephalitis in many countries of Asia. Although symptomatic Japanese encephalitis (JE) is rare, permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis. • There is no cure for the disease. Treatment is focused on relieving severe clinical signs and symptoms. The patient, a 21 years old female, student, came with complaints of deteriorating scholastic performance since 6-7 years of age; anger outburst, running away from home, self-harming behaviour since 10-11 years of age. At 3 years of age she had loss of consciousness for 15-20 days following an episode of fever after which she developed left sided hemiparesis and had 2-3 episodes of fits over 1.5 months after which she was diagnosed as a case of Japanese encephalitis. MRI showed multiple infarcts over basal ganglia, thalamus and brain stem. On examination patient had waddling gait, residual equine deformity at left foot along with right sided sensorineural hearing loss. On mental status examination she was anxious and had death wishes. • She was on treatment since 2012 and had best response on Tab Divalproex sodium 500mg + Risperidone 1mg on which she was maintaining since 2016. • Diagnosis of Post-encephalitis Syndrome was made and same medications were continued. • Cognitive remediation and neuropsychological rehabilitation was planned after detailed Neuropsychological & cognitive assessment.