Hemiplegia with dysarthria: an initial manifestation of

Japanese encephalitis (JE) was first recognised after an outbreak in Japan in 1924 that led to 6125 cases. Nearly, all the cases occur in children younger than 10 years, and more than 99% of infections are subclinical. After an incubation period of 4 to 14 days, the earliest symptoms are lethargy, nausea or abdominal pain, headache and fever. During a period of 2–3 days, lethargy increases and the child may exhibit uncharacteristic patterns of behaviour and motor abnormalities. Extra pyramidal signs usually develop in the second week of illness1. JE has a mortality rate of 10–20%, but may rise to 40–50% for comatose patients2. Here we describe a 4-year old child who presented with fever and left hemiplegia with left facial weakness and preserved consciousness throughout his illness but after fifth day onward developed extra pyramidal symptoms.