Encephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults
Identifieur interne : 001B47 ( Ncbi/Curation ); précédent : 001B46; suivant : 001B48Encephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults
Auteurs : Yanjun Guo [République populaire de Chine] ; Shuhui Wang [République populaire de Chine] ; Bin Jiang [République populaire de Chine] ; Jianle Li [République populaire de Chine] ; Lei Liu [République populaire de Chine] ; Jiawei Wang [République populaire de Chine] ; Weiqin Zhao [République populaire de Chine] ; Jianping Jia [République populaire de Chine]Source :
- Neuropsychiatric Disease and Treatment [ 1176-6328 ] ; 2017.
Abstract
Approximately 200 cases of mild encephalitis with reversible splenial (MERS) and deep cerebral white matter lesions have been reported since MERS was first defined in 2004. MERS occurs more frequently in children; in adults, only ~60 cases have been reported. Until now, only four cases of MERS in adults have been associated with Epstein–Barr virus (EBV).
We report three adult cases of MERS associated with EBV infection in China. For all three patients, cranial magnetic resonance imaging (MRI) indicated solitary reversible splenial and/or perilateral ventricle white matter lesions with reduced diffusion. In the present report, all patients were adults presenting with high fever, headache, apathy, and confusion, as well as significant signs of meningeal inflammation. These symptoms peaked 10–14 days after disease onset, with serious hyponatremia (112–129 mmol/L), an elevated cerebrospinal fluid white blood cell count (80–380/mm3), and significantly increased protein levels (1,010–1,650 mg/dL). Cranial MRI indicated abnormal signal intensity in the splenium of corpus callosum and symmetrically reversible lesions scattered in the thalamus and deep cerebral white matter. The clinical symptoms tended to improve after ~10–14 days of antiviral treatment. However, these patients recovered more slowly than patients with viral meningitis.
MERS associated with EBV infection in adults occurs less frequently but with more severe symptoms than in children. EBV infection should be considered for patients with MERS symptoms. MERS has a good prognosis.
Url:
DOI: 10.2147/NDT.S135510
PubMed: 28831257
PubMed Central: 5548266
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<series><title level="j">Neuropsychiatric Disease and Treatment</title>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Approximately 200 cases of mild encephalitis with reversible splenial (MERS) and deep cerebral white matter lesions have been reported since MERS was first defined in 2004. MERS occurs more frequently in children; in adults, only ~60 cases have been reported. Until now, only four cases of MERS in adults have been associated with Epstein–Barr virus (EBV).</p>
</sec>
<sec><title>Case presentation</title>
<p>We report three adult cases of MERS associated with EBV infection in China. For all three patients, cranial magnetic resonance imaging (MRI) indicated solitary reversible splenial and/or perilateral ventricle white matter lesions with reduced diffusion. In the present report, all patients were adults presenting with high fever, headache, apathy, and confusion, as well as significant signs of meningeal inflammation. These symptoms peaked 10–14 days after disease onset, with serious hyponatremia (112–129 mmol/L), an elevated cerebrospinal fluid white blood cell count (80–380/mm<sup>3</sup>
), and significantly increased protein levels (1,010–1,650 mg/dL). Cranial MRI indicated abnormal signal intensity in the splenium of corpus callosum and symmetrically reversible lesions scattered in the thalamus and deep cerebral white matter. The clinical symptoms tended to improve after ~10–14 days of antiviral treatment. However, these patients recovered more slowly than patients with viral meningitis.</p>
</sec>
<sec><title>Conclusion</title>
<p>MERS associated with EBV infection in adults occurs less frequently but with more severe symptoms than in children. EBV infection should be considered for patients with MERS symptoms. MERS has a good prognosis.</p>
</sec>
</div>
</front>
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