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[Fulminant cerebello-brainstem encephalitis with polyradiculitis following probable Epstein-Barr virus infection]

[Article in Japanese]

Koguchi Y, Yagishita T, Sato A, Watanabe Y.

Department of Neurology, Chiba Emergency Medical Center.

Epstein-Barr virus (EBV) infection is occasionally accompanied by acute neurological impairment. The pathogenesis of neurological manifestations with EBV infection consists of primary inflammations of EBV infection, and secondary immunologic reactions. However, their clinical course and prognosis are usually favorable. Here we report a patient with fulminant neurological involvement in association with EBV infection. The patient was a 44-year-old man. One morning he developed ataxic gait and speech following flu-like symptoms. He noticed double vision in the afternoon. He had disturbance of consciousness, bilateral ptosis with mydriasis, opthalmoplegia, facial diplegia, bulbar palsy, and weakness of muscles in extremities and respiratory system on the next day. He required mechanical ventilatory support for a month. His symptoms began to improve gradually two weeks after the onset. Two month later, neurological examinations disclosed severe cerebellar ataxia of the four extremities and ocular movement, cerebellar speech, and moderate weakness in his limbs. Moderate cerebellar ataxia and diminished deep tendon reflexes remained for 8-months. Although he had no physical manifestations of infectious mononucleosis, DNA of EBV was identified in the cerebrospinal fluid (CSF) by the polymerase chain reaction method. From these results, we diagnosed his condition as a cerebello brainstem encephalitis with polyradiculitis associated with EBV infection. The cell counts and protein content of CSF gradually normalized in the early stage of his illness, but CSF protein increased again, and had the peak of 275 mg/dl in about one month. In spite of normalized CSF cell counts, his neurological symptoms persisted. CT scan and MRI studies of the brain and the spinal cord were repeated, but demonstrated no significant abnormalities. Clinical course and CSF findings revealed that his fulminant neurological symptoms were most likely produced by the secondary immunologic reactions following the primary inflammations by EBV infection.

PMID: 9046853 [PubMed - indexed for MEDLINE]

Acute cerebellitis caused by Epstein-Barr virus: case report]

[Article in Portuguese]

Teive HA, Zavala JA, Iwamoto FM, Bertucci-Filho D, Werneck LC.

Servico de Neurologia, Hospital de Clinicas, Universidade Federal do Parana, Curitiba, PR, Brasil. hagteive@mps.com.br

Acute cerebellitis can occur in association with varicella-zoster virus, enterovirus, mumps, mycoplasma, and other infective organisms. Acute cerebellitis is a rare complication of Epstein-Barr virus (EBV) infection. We report the case of a 21-year-old woman with a 12-day history of nausea and vomiting, gait and limbs ataxia, myoclonus, tremor of head and all four limbs, opsoclonus and cutaneous rash. Anti-EBV IgG and IgM antibodies against antiviral capsid were positive and anti-EBV against virus-associated nuclear antigen was also positive. EBV infection in association with neurological findings can occur without the classic signs and symptoms of infectious mononucleosis.

PMID: 11588648 [PubMed - indexed for MEDLINE]

this is absolutely crucial for people whio have had severe EBV of Mono to read this.

Quote:

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The patient was a 44-year-old man. One morning he developed ataxic gait and speech following flu-like symptoms. He noticed double vision in the afternoon. He had disturbance of consciousness, bilateral ptosis with mydriasis, opthalmoplegia, facial diplegia, bulbar palsy, and weakness of muscles in extremities and respiratory system on the next day. He required mechanical ventilatory support for a month. His symptoms began to improve gradually two weeks after the onset. Two month later, neurological examinations disclosed severe cerebellar ataxia of the four extremities and ocular movement, cerebellar speech, and moderate weakness in his limbs. Moderate cerebellar ataxia and diminished deep tendon reflexes remained for 8-months. Although he had no physical manifestations of infectious mononucleosis, DNA of EBV was identified in the cerebrospinal fluid (CSF) by the polymerase chain reaction method. From these results, we diagnosed his condition as a cerebello brainstem encephalitis with polyradiculitis associated with EBV infection.

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Peggy I missed this earlier. Hah this one is a whopper isn't it with the science words? I guess only a doctor could explain it, but what I was looking for was evidence that yes, indeed chronic mono [which in me are FMS symptoms], might be a result of this. When I was in my worst flare I had all the symptoms of a neuro/spinal encephalitis going on. That can come from many things, or many bacterias or viruses. In my wandering thru abstracts I do see some inferrence of EBV mono inflamation and many other herpes viruses causing acute muscle pain and weakness, etc. This is probably rare, but how many never go to a doctor and think they just have a horrible flu? I was so ill for months. And my neck and spine pain was on fire. I thought that was a separate issue, as most doctors do. But it's possible that it could have been the reactivation of EBV virus that caused all the pain and neuro problems. [similar to this guy above.]