NEUROLOGICAL MANIFESTATIONS OF HEMORRHAGIC-FEVER WITH RENAL SYNDROME CAUSED BY PUUMALA VIRUS - REVIEW OF 811 CASES

Eight-hundred eleven case records of patients with hemorrhagic fever w ith renal syndrome (HFRS) caused by Puumala virus were reviewed, and p articular attention was given to data regarding severe neurological ma nifestations. The most common symptoms were headache (97%), blurred vi sion (40%), and vomiting (31%); 27% of the patients had all three. Nin e patients (1%) had severe neurological manifestations: meningism and cerebral hemorrhage occurred during the first week of illness, whereas epileptiform seizures and urinary bladder paralysis developed during the second week. In terms of the severity of renal failure, as evidenc ed by maximum serum creatinine levels, there was no difference between patients with or without severe neurological conditions. There was on e fatal case due to cerebral hemorrhage; the other patients with sever e neurological manifestations clinically recovered and did not have an y neurological signs during 6 months of follow-up. HFRS caused by Puum ala virus, or a variant of it, map be associated with severe, potentia lly life-threatening neurological complications.