Background: Rasmussen's encephalitis (RE) is a rare, chronic, immune-mediated neurological disorder of childhood characterized by progressive unihemispheric inflammation, intractable seizures, and functional decline. Haemorrhagic onset in early infancy is extremely uncommon and may obscure the underlying inflammatory etiology. Early recognition supported by multimodal investigations is critical, as timely surgical intervention can dramatically improve seizure control and long-term outcomes.
Case Report: A case of a male child who initially presented at 2 years of age with a massive right temporoparietal intracerebral haemorrhage measuring 4.8 × 4.5 cm, associated with subdural extension, midline shift, and early transtentorial herniation. Serial neuroimaging during infancy and early childhood demonstrated progressive cystic encephalomalacia, gliosis, unilateral white matter loss, periventricular leukomalacia, and advanced hemispheric atrophy with Wallerian degeneration. Clinically, he developed global developmental delay, persistent left hemiparesis, and refractory seizures occurring 2–3 times daily. EEGs consistently showed marked hemispheric asymmetry and epileptiform discharges. Owing to failure of multiple antiepileptic drugs, a neuronavigation-guided right functional hemispherotomy was performed at 6 years of age. Histopathology of temporal, hippocampal, and meningeal tissue confirmed Rasmussen's encephalitis. Peri-operative anaesthetic management was particularly challenging due to severe unihemispheric dysfunction, Cheyne–Stokes–type respiratory irregularity, non-verbal status, and high seizure propensity. Total intravenous anaesthesia (TIVA) guided by bispectral index (BIS) monitoring was used to maintain stable cerebral physiology and minimise seizure risk. Fibre-optic nasal intubation with a flexometallic tube ensured safe airway control in an uncooperative neurologically impaired child. Postoperatively, he achieved complete seizure freedom and gradual neurological stabilization. Follow-up EEGs showed persistent asymmetry without epileptiform activity.
Keywords: Rasmussen's encephalitis, intracerebral hemorrhage, pediatric seizures, hemispherotomy, Wallerian degeneration, encephalomalacia, microglial nodules, drug-resistant epilepsy.
How to cite this article: Addhavan RS, Kedareshvara KS, Anaesthetic Challenges In A Case Of Rasmussen's Encephalitis In Early Childhood Presenting With Neonatal Intracerebral Haemorrhage And Progressive Hemispheric Failure Posted For Hemispherotomy: A Case Report. Int J Drug Deliv Technol. 2026;16(4s): 184-190; DOI: 10.25258/ijddt.16.184-190