Virus meningo-encephalitis in Austria. II. Clinical features, pathology, and diagnosis

This paper reports on the clinical and pathological features as well as the diagnosis of 304 cases of virus meningo-encephalitis hospitalized at the Neurological Clinic, Graz, during the 1953 epidemic in Styria, Austria. Of these cases, 175 were of an aparalytic meningeal form, 50 preparalytic, 27 spinal paralytic, 20 bublo-spinal or ascending paralytic, 7 bulbar paralytic, 3 radiculitic or transmyelitic, and 22 encephalitic. The case-fatality rate was 4.6%. The clinical course of the disease-usually diphasic-and the changes in the spinal fluid showed a close similarity to those seen in poliomyelitis, but the paralysis preferentially involved the shoulder-girdle and upper arm.The post-mortem examination showed a picture of acute encephalitis, with changes in the grey matter particularly. Histological findings revealed extensive involvement of the anterior horns of the spinal cord, the medulla oblongata, and the pons, and especially of the Purkinje's cells of the cerebellum.In making a diagnosis, the possibility of louping-ill, Russian spring-summer encephalitis, Czech tick encephalitis, and, particularly, poliomyelitis must be taken into account. The author points out that it is impossible to distinguish the virus meningo-encephalitis of this epidemic from poliomyelitis on the basis of clinical and post-mortem findings alone; a differential diagnosis must rest on serological and immunological grounds.Finally, the symptomatic and supporting treatment given is described.