Introduction: Encephalopathy is a structural and/or functional disorder of the brain with multiple causes, one of them being acute viral infection. It is clinically presented with a variety of neurological and psychiatric symptoms - muscle weakness, poor concentration, seizures, changes in personality, as well as lethargy or psychosis.
Materials and methods: A 12-year-old patient is being presented, hospitalized in the past due to viral encephalitis. Symptoms included fever, nausea, drowsiness, apathy and confusion. A lumbar puncture was performed at the time with no pathogens found in the cerebrospinal fluid. After a psychiatric assessment through an interview the patient was diagnosed with organic personality disorder. Therapy was conducted and after the full resolution of the patient`s condition he was discharged. An year and a half later a relapse of previous symptomatology occurred. The boy was hospitalized again in a psychosis-like state after an interview with a psychiatrist.
Results: Beginning with fever the second episode included visual hallucinations, photophobia and disorientation, psychosis-like beliefs - believing his mother is not real (Capgras syndrome). Although fully managing the first episode a therapy with Aripiprazole and Finlepsin only lead to a partial improvement and fluctuation of the condition during the relapse. A follow up and additional examinations were commissioned.
Conclusion: Even though long term complications are rare the condition should be treated with care. Neuropsychiatric symptoms are common in the acute phase of viral encephalitis. In rare cases they may also reappear after recovery, especially in children. Symptoms may present as psychosis (35%), catatonia (33%), psychotic depression (16%), and mania (11%). Post-infectious structural and functional changes in the brain may lead to personality shifts, e.g. detachment from reality and disinhibited behaviour resulting in long-term disability and social isolation of the patient. Psychiatric consultation and follow-up should be requested for patients at risk without hesitation.
