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Acute arcuate fiber demyelinating encephalopathy following Epstein-Barr virus infection
J F Paskavitz1, C A Anderson, C M Filley
1Department of Neurology, University of Colorado Health Sciences Center, Denver, USA.
Abstract:
We describe a patient who presented with an acute monophasic illness characterized by behavioral abnormalities, visual illusions, and a seizure, who had magnetic resonance- and brain biopsy-documented evidence of multifocal central nervous system demyelination. Serological studies were diagnostic of recent Epstein-Barr virus infection and included evidence of intrathecal synthesis of Epstein-Barr virus-specific IgG antibodies against the viral capsid antigen. Viral DNA could not be amplified from cerebrospinal fluid by polymerase chain reaction, and viral antigen and genome were not detected in the brain biopsy specimen. The patient's clinical course, diagnostic studies, and neuropathological findings all support the diagnosis of a postinfectious Epstein-Barr virus-mediated demyelinating encephalopathy.
Insights
A rare case of Epstein-Barr virus-mediated demyelinating encephalopathy presented with neurological symptoms. This post-infectious condition involved central nervous system demyelination, confirmed by MRI and biopsy.
Area of Science:
- Neurology
- Immunology
- Virology
Background:
- Central nervous system demyelination can manifest with diverse neurological symptoms.
- Epstein-Barr virus (EBV) infection is common, but its role in acute demyelinating encephalopathy is less understood.
Observation:
- A patient presented with acute behavioral changes, visual illusions, and seizures.
- Magnetic resonance imaging (MRI) and brain biopsy revealed multifocal central nervous system demyelination.
Findings:
- Serological tests confirmed recent Epstein-Barr virus infection.
- Intrathecal synthesis of EBV-specific IgG antibodies was detected.
- No viral DNA, antigen, or genome was found in cerebrospinal fluid or brain biopsy.
Implications:
- The findings support a diagnosis of postinfectious Epstein-Barr virus-mediated demyelinating encephalopathy.
- This case highlights the potential for EBV to trigger autoimmune demyelinating processes in the CNS.
- Further research is needed to elucidate the mechanisms of EBV-associated demyelination.