2026 American Academy of Neurology Abstract Website

Objective:

Report of a case of fraternal twins presenting with seizures associated with enterovirus meningitis and bilateral frontopareital restricted diffusion on MRI.

Background:

Enterovirus Meningitis is typically a mild, self-limiting infection; however, it can present with greater severity in infants.

Design/Methods:

N/A

Results:

We present a case of di-di twin gestation males born at 36 weeks 1 day via caesarean section for breech presentation of Twin B. Two weeks after birth, both twins presented with decreased weight, increased lethargy, and hypothermia. Twin A had bilateral rhythmic jerking movements of the arms, lip-smacking and associated apneic episodes treated with intravenous versed and phenobarbital. Twin B presented with bilateral arm extension and associated apneic events treated with intravenous versed. On the day of admission, CT head without contrast for both showed bi-frontal hypodensities with concern for edema.

Twin A’s EEG showed frequent focal electrographic with clinical seizures arising from the vertex and right greater than left central regions. Twin B’s EEG also showed focal electrographic seizures arising from the vertex and right greater than left central regions, however most were not clinical.

Persistent seizures were treated with Levetiracetam (load without maintenance) and Phenobarbital (load followed by maintenance). Meningitis-Encephalitis panel for both twins was positive for enterovirus. MRI scans at age 26 days showed extensive areas of restricted diffusion involving the frontal lobes, parietal lobes, and genu of the corpus callosum in both infants, consistent with acute to early subacute ischemic infarction with some petechial hemorrhage. They were discharged after 10 days. At 2 months old they were achieving normal developmental milestones.

Conclusions:

A unique case of fraternal twins presenting at two weeks chronological age with seizures associated with ischemic brain injury in the setting of enterovirus meningoencephalitis. This case demonstrates that in infants with enteroviral central nervous infection we should also consider acute ischemic infarct.