[Past hepatitis B virus infection and demyelinating multiphasic disease: casual or causal relationship?].
BACKGROUND
The relationship between hepatitis B virus and hepatitis B vaccine with central nervous system demyelinating diseases is controversial.


METHODS
We describe two male patients, who in their 70's developed recurrent pictures of acute demyelinating diseases. The first one had recurrent acute disseminated encephalomyelitis (diplopia, paraparesis and urinary retention) and the second one recurrent transverse myelitis (paraparesis and urinary retention).


RESULTS
The cerebrospinal fluid test showed mononuclear pleocytosis with negative oligoclonal bands in both patients. Visual evocated potentials were normal. Magnetic resonance imaging (T2-WI and FLAIR) showed hyperintense lesions located in the brain and spinal cord in the first case and only in the spinal cord in the second. With negative antigenemia, antibodies against hepatitis B core and hepatitis B surface antigens were positive in both patients. No patient had been vaccinated for nor had suffered symptomatic hepatic disease. In the second patient, there was an almost total remission of the symptoms with periodic treatment with immunoglobulins.


CONCLUSIONS
We recommend hepatitis B virus infection investigation in all patients with central nervous system demyelinating disease.
Santos-García
D
D
Servicio de Neurología, Complejo Hospitalario Universitario, Santiago de Compostela, Spain. diegosangar@yahoo.es
Arias-Rivas
S
S
Dapena
D
D
Arias
M
M
D000368:Aged; D002555:Cerebrospinal Fluid / Q000166:cytology; D003711:Demyelinating Diseases / Q000134:cerebrospinal fluid / Q000150:complications* / Q000628:therapy; D004172:Diplopia / Q000209:etiology; D004679:Encephalomyelitis / Q000209:etiology; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis; D006512:Hepatitis B Core Antigens / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007964:Leukocytosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009188:Myelitis, Transverse / Q000209:etiology; D012008:Recurrence; D012074:Remission Induction; D016055:Urinary Retention / Q000209:etiology
D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D008775:Methylprednisolone