Encephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults

Encephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults

Yanjun Guo,1 Shuhui Wang,1 Bin Jiang,1 Jianle Li,1 Lei Liu,2 Jiawei Wang,2 Weiqin Zhao,1 Jianping Jia1 1Department of Neurology, Beijing Friendship Hospital, Capital Medical University. Beijing, China; 2Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China B...

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Autores principales: Guo YJ, Wang SH, Jiang B, Li JL, Liu L, Wang J, Zhao WQ, Jia J
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2017
Materias:
Mild encephalitis with reversible splenial
Epstein-Barr virus
Magnetic Resonance imaging
Adults
Case report
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
Acceso en línea:https://doaj.org/article/bdc3533ab3d04cd7aa9b1039647d207c
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spelling oai:doaj.org-article:bdc3533ab3d04cd7aa9b1039647d207c2021-12-02T05:58:14ZEncephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults1178-2021https://doaj.org/article/bdc3533ab3d04cd7aa9b1039647d207c2017-08-01T00:00:00Zhttps://www.dovepress.com/encephalitis-with-reversible-splenial-and-deep-cerebral-white-matter-l-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Yanjun Guo,1 Shuhui Wang,1 Bin Jiang,1 Jianle Li,1 Lei Liu,2 Jiawei Wang,2 Weiqin Zhao,1 Jianping Jia1 1Department of Neurology, Beijing Friendship Hospital, Capital Medical University. Beijing, China; 2Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China Background: 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). Case presentation: 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. Conclusion: 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. Keywords: mild encephalitis with reversible splenial lesions, Epstein-Barr virus, apathy, hyponatremia, corpus fluid Guo YJWang SHJiang BLi JLLiu LWang JZhao WQJia JDove Medical PressarticleMild encephalitis with reversible splenialEpstein-Barr virusMagnetic Resonance imagingAdultsCase reportNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 13, Pp 2085-2092 (2017)
institution DOAJ
collection DOAJ
language EN
topic Mild encephalitis with reversible splenial
Epstein-Barr virus
Magnetic Resonance imaging
Adults
Case report
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
spellingShingle Mild encephalitis with reversible splenial
Epstein-Barr virus
Magnetic Resonance imaging
Adults
Case report
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
Guo YJ
Wang SH
Jiang B
Li JL
Liu L
Wang J
Zhao WQ
Jia J
Encephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults
description Yanjun Guo,1 Shuhui Wang,1 Bin Jiang,1 Jianle Li,1 Lei Liu,2 Jiawei Wang,2 Weiqin Zhao,1 Jianping Jia1 1Department of Neurology, Beijing Friendship Hospital, Capital Medical University. Beijing, China; 2Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China Background: 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). Case presentation: 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. Conclusion: 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. Keywords: mild encephalitis with reversible splenial lesions, Epstein-Barr virus, apathy, hyponatremia, corpus fluid 
format article
author Guo YJ
Wang SH
Jiang B
Li JL
Liu L
Wang J
Zhao WQ
Jia J
author_facet Guo YJ
Wang SH
Jiang B
Li JL
Liu L
Wang J
Zhao WQ
Jia J
author_sort Guo YJ
title Encephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults
title_short Encephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults
title_full Encephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults
title_fullStr Encephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults
title_full_unstemmed Encephalitis with reversible splenial and deep cerebral white matter lesions associated with Epstein–Barr virus infection in adults
title_sort encephalitis with reversible splenial and deep cerebral white matter lesions associated with epstein–barr virus infection in adults
publisher Dove Medical Press
publishDate 2017
url https://doaj.org/article/bdc3533ab3d04cd7aa9b1039647d207c
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