ACUTE MANIFESTATIONS AND NEUROLOGIC SEQUELAE OF EPSTEIN-BARR-VIRUS ENCEPHALITIS IN CHILDREN

Background. Complications of Epstein-Barr virus (EBV) infection are di verse and include a number of neurologic manifestations such as mening itis, meningoencephalitis, cerebellitis, cranial neuritis and others. In general encephalitis caused by EBV in pediatric patients has been c onsidered a self-limited illness with few or no sequelae. Methods. Cha rts were reviewed from all patients <18 years of age admitted to or di scharged from the State University of New York Health Science Center a t Syracuse between 1982 and 1992 with a diagnosis of encephalitis or m eningoencephalitis. Eleven cases of EBV encephalitis diagnosed during a 10-year period were reviewed to characterize the clinical and labora tory findings in the acute setting and the extent of neurologic sequel ae on follow-up. Results. Acute neurologic manifestations were diverse and included combative behavior (55%), seizures (36%), headache (36%) and evidence of focal involvement (27%). Classic findings of infectio us mononucleosis were noted infrequently; 18% each had pharyngitis, ad enopathy, positive heterophile antibody tests or atypical lymphocytosi s. Two patients (18%) had abnormal neuroimaging studies, one in the ac ute stage and the other at the time of follow-up. Seven patients (64%) had abnormal electroencephalograms (EEGs) in the acute setting; of th ese three had persistent abnormalities on follow-up. Forty percent dev eloped persistent neurologic abnormalities including global impairment , perseverative autistic-like behavior and persistent left upper extre mity paresis. Conclusions. Classic signs, symptoms and laboratory find ings in infectious mononucleosis may be absent in Epstein-Barr virus e ncephalitis. Neurologic sequelae occur in a substantial number of pati ents.