[Severe course of tick-borne encephalitis (Encephalomeningomyelitis): a case report].

A 19-year-old male student was admitted to the Department of Infectious Diseases and Neuroinfections with suspected encephalomeningitis. Three weeks before admission the patient was bitten by a tick. The first symptoms were manifested by mild consciousness disorders, headache, vomiting, and fever with the presence of meningeal syndrome. In the course of the disease, the signs of focal lesions in the central nervous system developed: horizontal nystagmus, bilateral ptosis, paresis of cranial nerves: peripheral damage to nerve VII on the right and nerve XI, weakness of proximal muscles of upper and lower extremities. Examination of the cerebrospinal fluid showed lymphocytic pleocytosis with the presence of antibodies against TBE virus. CT and MRI scans did not show any pathology. The applied treatment reduced neurological abnormalities. In the course of the disease, generalized convulsions were twice observed. On the day of discharge, slight nystagmus, bilateral ptosis with normal movement of eyeballs, slight peripheral paresis of nerve VII on the right and nerve XI, massive paresis of the shoulder girdle muscles as a result of their atrophy were found. Mental status was normal. Residual signs of peripheral paresis of peripheral nerve VII, slight nystagmus as well as paresis and atrophy of the shoulder girdle muscles are still present.