1 –Serviço de Neurorradiologia, Hospital de São José, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
2 - Serviço de Neurorradiologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
3 - Serviço de Neurologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
4 - Unidade de Infecciologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa
– II Reunião Ibérica de Neurorradiologia, Lisboa 17-19 Out 2013 (Comunicação oral)
Introduction: Epstein - Barr virus (EBV) is associated with infectious mononucleosis (IM). In rare cases, it causes neurological complications such as meningoencephalitis, frequently in the absence of a previous history of IM. The clinical presentation and the presence of serological and/or cerebrospinal fluid (CSF) evidence of EBV infection can point out the diagnosis of a nervous system infection by this virus and occasionally the Magnetic Resonance Imaging (MRI) can demonstrate lesions. The three case reports we discuss in this work present a similar imagiological pattern, affecting the basal ganglia and / or thalamus.
Clinical reports: In the last three months, we had three cases of meningoencephalitis with evidence of EBV acute infection in the blood serology and/or CSF: two girls and a boy with ages between twenty months and eleven years. None of them had a relevant personal history. In the three cases, the patients had symptoms of an upper respiratory tract infection about a week before they were hospitalized and had persisting fever, alteration of the state of consciousness and speech and an epileptic crisis. In addition, one of the patients also developed myoclonias, dysmetria and ataxia and another one presented with a convergent strabismus with paresis of the VI left cranial nerve. Strikingly, the MRI revealed a similar pattern in the three cases which consisted of unilateral / bilateral hyperintensities in T2 and FLAIR sequences that affected the basal ganglia and / or thalamus, without diffusion restriction. Moreover, other regions were also affected such as substantianigra, sub-insular regions, the white matter and pons.
Conclusion: EBV meningoencephalitis can present with different clinical and imagiological characteristics - sometimes overlapping with other virus infectionsmaking the definitive diagnosis a challenge. Surprisingly, we had three cases of EBV encephalitis in a short period of time that demonstrated a similar MRI pattern, affecting the basal ganglia and / or thalamus. This suggests a possible EBV tropism for these structures, imposing the need for further investigation.
Keywords: Epstein - Barr virus, encephalitis