11 year old Girl with Diagnosis of Encephalitis

[tcnoskey]

I need some help on finding out what is wrong with my niece.  Mid April she had a fever for 1.5 days and then had a 10 day episode where she was not very coherent, she was drowsy and did not respond to her surroundings.  After the 10th day, she came out of this and said it was"like she was trapped in her own head".  All labs, head CT, head MRI and EEG were normal.  She also had swabs done that were all negative.  The pediatrician said that it could be viral encephalitis.  
Two weeks later, she developed the same symptoms (lasting 7 days this time), the family physician said that this must be mental illness.  The parents went back to the pediatrician who also said, since all labs and test were normal that a consult with psychiatry would be arranged (also stated that encephalitis does not reoccur).  After the psych assessment, the psychiatrist said this was not mental illness but something organic.  He agreed to keep her as a patient as the other specialists were putting her off as all the diagnostics are normal.
Just last week, she went into this state again and it lasted 4 days.
From observing her and what she tells us is that when it starts, it feels like her ear(s) are plugged and then for the duration of the episode her hearing is "muffled".  After she comes out of this, her memory is patchy (she remembers some things but not others), she finds it easier to write things down than to verbalize in this state.  Her emotions are flat and she is frightened when she comes out of it as she does not want to lapse back into this state.  
Is there something that everyone is missing?  Can encephalitis reoccur over long periods?  All Drs have said she has fluid in her ears.
Please help!

[tcnoskey]

She has had spinal tap which was normal and had also had two EEGs which were also normal.  She has not had a significant history of headaches.

It does not make sense why it would occur right after the fever.  She has also seen a pediatric neurologist in which the assessment was normal.  Maybe another opinion is warranted.

Thank you.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

A viral encephalitis would be unlikely given the stereotypic nature of the events. Has your niece had a spinal tap to evaluate for an infection or inflammatory process in the cerebrospinal fluid? Also, it may be worthwhile to have an EEG performed to evaluate the electrical nature of the brain (i.e., to evaluate for a seizure focus). The length of time (ie., 4 days) would be unusual, but it may be worthwhile pursuing.

Also, does your niece have a history of headaches? Migraines are common in children and can present in a variety of ways.

I would suggest that a pediatric neurology evaluation be performed but continue following up with the psychiatrist as already recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.