Acute manifestations and neurologic sequelae of Epstein-Barr virus encephalitis in children.
BACKGROUND
Complications of Epstein-Barr virus (EBV) infection are diverse and include a number of neurologic manifestations such as meningitis, meningoencephalitis, cerebellitis, cranial neuritis and others. In general encephalitis caused by EBV in pediatric patients has been considered a self-limited illness with few or no sequelae.


METHODS
Charts were reviewed from all patients < 18 years of age admitted to or discharged from the State University of New York Health Science Center at Syracuse between 1982 and 1992 with a diagnosis of encephalitis or meningo-encephalitis. Eleven cases of EBV encephalitis diagnosed during a 10-year period were reviewed to characterize the clinical and laboratory findings in the acute setting and the extent of neurologic sequelae on follow-up.


RESULTS
Acute neurologic manifestations were diverse and included combative behavior (55%), seizures (36%), headache (36%) and evidence of focal involvement (27%). Classic findings of infectious mononucleosis were noted infrequently; 18% each had pharyngitis, adenopathy, positive heterophile antibody tests or atypical lymphocytosis. Two patients (18%) had abnormal neuroimaging studies, one in the acute stage and the other at the time of follow-up. Seven patients (64%) had abnormal electroencephalograms (EEGs) in the acute setting; of these three had persistent abnormalities on follow-up. Forty percent developed persistent neurologic abnormalities including global impairment, perseverative autistic-like behavior and persistent left upper extremity paresis.


CONCLUSIONS
Classic signs, symptoms and laboratory findings in infectious mononucleosis may be absent in Epstein-Barr virus encephalitis. Neurologic sequelae occur in a substantial number of patients.
Department of Pediatrics, State University of New York, Health Science Center at Syracuse, USA. jdomach@helix.nih.gov
J B
JB
Domachowske
C K
CK
Cunningham
D L
DL
Cummings
C J
CJ
Crosley
W P
WP
Hannan
L B
LB
Weiner
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D018792:Encephalitis, Viral / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007244:Infectious Mononucleosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis / Q000821:virology; D012698:Serologic Tests