Autism Following Viral Infection

I just discovered a remarkable case report from 1986 about a Swedish girl who developed all of the major symptoms of autism at the age of 14, following a severe brain infection.

Autism generally becomes noticeable in early childhood. There are plenty of cases in which autistic people don't get diagnosed until much later in life, but the symptoms invariably turn out to go back a long way. Older children, teenagers and adults don't just go autistic overnight. Except in this case, if you believe it.

The patient, "A", was born to healthy parents and developed perfectly normally, though she was described as somewhat shy. Just before her 14th birthday, she became ill with what at first seemed to be nothing more than a fever and mild headache.

However, a week later, she developed a severe headache and had a seizure. After being rushed to hospital, she was unconscious for a few hours and then awoke, tired but fairly lucid. However, her recovery was only temporary:

On day 6 there was a severe aggravation of symptoms and she became confused, part of the time verbally and physically aggressive, at other times tired and apathetic. She kept complaining of the headache.

These complaints would be perhaps the last time she would use language appropriately for the purposes of communication.

From day 10 she became autistic, reacting not to people but to pain. She would avert her gaze when approached. She was still febrile.... From day 12 to day 19 she was sometimes comatose and sometimes awake, "looking through people with her empty staring gaze," in the words of her mother (day 18) according to the medical records. She reacted with a pained facial expression even to rather slight noises (day 19).

She then began to recover some of her faculties, but only some:

On day 33: "lying in bed, accepting food orally for the first time, avoiding gaze contact but looking around her when she is not observed. Obviously sensitive to smells and taste. Empty, autistic like gaze."

Day 40: "still quite 'fenced-off' but manipulated small objects with great skill. She echoed what nurses and mother said to her. Wrote simple words. Laughed in odd situations and raged with anger without obvious cause."

Day 45: "autistic, not responding to social interactions, but echoing long phrases and sometimes chatting away in a cocktail party fashion."

Autism is defined by a 'triad' of symptoms: difficulties with social interaction; difficulties with communication; and insistence on sameness, or repetitive interests and behaviours.

Of these, it's perhaps not surprising that brain damage could cause the first two. We socialize and communicate with our brains, so of course damage could cause difficulties. What makes this case remarkable is that the patient also developed the third element of triad, repetitive behaviours.

From day 70 bilateral flapping stereotypies of the hands were observed. She had also had bouts when she would laugh intensively and jump up and down, surreptitiously... She would carry with her small plastic objects and protest if these were removed. She would scream for hours if daily routines were changed in any way.

10 years later, when the case report was written, her condition had changed only slightly.

At the age of 22 years she moved to a small group home for mentally retarded persons... The most severe problem nowadays is her insistence on sameness. She absolutely refuses to go to the bathroom and screams for a quarter of an hour every morning before she finally accepts... Then she refuses to leave the bathroom and screams for another quarter of an hour. This pattern is followed every day without fail and intrudes on almost all activities of daily life.

What happened to her? She suffered from herpes simplex encephalitis, a viral infection of the brain. X-rays at the age of 22 showed serious damage to the temporal lobes of the brain, extending to parts of the parietal lobes. (No pictures were provided, however.)

Can her case really be described as a "typical autistic syndrome"? Certainly, there are striking similarities, from the obsessive routines, to the echolalia (repeating what other people say), to the avoidance of eye contact, all classic symptoms of severe autism.

Of course it's always possible that the case report was written to accentuate these similarities, in order to make a nice publication. There have been a handful of other similar cases, though the same caveats apply. Still, if we do accept that these patients are indeed autistic, the implications for understanding the neurobiology of "normal" autism are obvious.

Link: "The Man With Half A Brain" who developed a rather different pattern of symptoms after herpes encephalitis.

Gillberg, C. (1986). Brief report: Onset at age 14 of a typical autistic syndrome. A case report of a girl with herpes simplex encephalitis Journal of Autism and Developmental Disorders, 16 (3), 369-375 DOI: 10.1007/BF01531665