Eastern Equine Encephalitis: A Case Report

Purpose: The purpose of this case report is to discuss a rare case of rapid neurological recovery from eastern equine encephalitis (EEE). Methods: Information and records were obtained on a 53 year old white male diagnosed with eastern equine encephalitis who initially presented to a Fort Worth, Texas emergency department with new onset slurred speech, confusion and weakness upon waking. The patient had a one week history of worsening headaches, waxing and waning fevers, upper back pain, nausea and vomiting. He had been diagnosed with a non-life-threatening viral illness two days prior to presentation. A thorough literature review on EEE was also conducted. Results: Within a few hours of arrival the patient experienced acute flaccid paralysis and a decline in respiratory status requiring emergent intubation. After three days of supportive care in the ICU he was extubated and began rehabilitation therapy. Physical therapy helped to rapidly improve his muscle strength, gait and fine motor skills over the course of one week. At follow-up five weeks later he was able to drive and start working again. He was still in speech therapy twice weekly, but noted improvement. Conclusion: Only 2% of adults infected with the EEE virus develop encephalitis. Of those 2%, 90% become comatose or stuporous. The mortality rate is at least 30%, making it the most severe arboviral encephalitis. Complete recovery among survivors is rare, with the most common sequelae being convulsions, paralysis and mental retardation. This patient was one of the unlucky few to develop encephalitis from the virus. He managed to survive and recover rapidly with no major sequelae.