[Acute cerebellar ataxia with sympathotonic orthostatic hypotension following Epstein-Barr virus infection--a case report].
A 21-year-old man with acute cerebellar ataxia and sympathotonic orthostatic hypotension, following Epstein-Barr (EB) virus infection, was reported. He noticed unsteady gait 2 weeks after the development of cough, nausea and vomiting. On admission, he was unable to sit and walk due to truncal ataxia and orthostatic hypotension with marked tachycardia. Limb ataxia of moderate degree was also noted. The blood pressure was 112/42 mmHg, and the pulse rate was 64/min in supine position, and 5 minutes after standing, they were 82/42 mmHg and 128/min. In laboratory studies, no atypical lymphocytes were detected in the peripheral blood. However, the titers of antibodies, VCA-IgM, against EB virus, were x80 and x160 in serum, respectively. And the titer of VCA-IgM subsequently decreased to the normal level in two months. They were negative in the cerebrospinal fluid. The results of the autonomic function studies revealed dysfunctions of the sympathetic post-ganglionic nerves, especially of alpha-adrenergic system, with preservation of beta-adrenergic system. He recovered from cerebellar ataxia and from sympathotonic orthostatic hypotension 3 and 8 months after the onset, respectively, without residuals.
Department of Neurology, University of Occupational and Environmental Health.
Y
Y
Itoh
T
T
Oishi
A
A
Ohnishi
Y
Y
Murai
R
R
Imawatari
D000208:Acute Disease; D000328:Adult; D002524:Cerebellar Ataxia / Q000209:etiology*; D006566:Herpesviridae Infections / Q000150:complications*; D004854:Herpesvirus 4, Human; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D013564:Sympathetic Nervous System / Q000503:physiopathology*