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Poster abstract
040 Acute cerebellar ataxia following epstein-barr virus infection
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  1. Stephanie L Barnes1,
  2. Bruce J Brew2,3,4
  1. 1Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
  2. 2Departments of Neurology and Immunology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
  3. 3Peter Duncan Neurosciences Research Unit, St Vincent’s Centre for Applied Medical Research, Darlinghurst, NSW, Australia
  4. 4St Vincent’s Clinical School, Faculty of Medicine, University of NSW and University of Notre Dame Sydney, Sydney, NSW, Australia

Abstract

Introduction Infectious aetiologies such as acute Epstein-Barr virus (EBV) infection are in the differential diagnosis for acute cerebellar ataxia (ACA). This syndrome remains exceptionally rare and not well characterised in adults.e.g. 1 2

Methods A retrospective case review of a patient diagnosed with ACA following EBV infection with implications for pathogenesis and treatment.

Results A 29-year-old Caucasian male presented with a three day history of ACA. Seven days prior he was diagnosed with infectious mononucleosis; bloodwork was consistent with acute EBV infection. These symptoms improved rapidly with oral prednisolone. He took no regular medications, drank alcohol moderately and had no significant family history.

On examination, he was afebrile, ataxic and mildly dysarthric. Sensory examination was normal, particularly proprioception. Romberg’s test was negative. Remaining neurological and general examination was normal.

Bloodwork showed mild liver dysfunction and positive ANA (titre 1/320, homogenous and speckled patterns). Immune screen was otherwise negative. Antineuronal antibody panel was negative in serum and CSF. CSF glucose was 3.1 mmol/L, protein 751 mg/L, albumin 523 mg/L, neopterin 24 nmol/L and B2 microglobulin 1.1 mg/L. The sample was acellular with negative EBV PCR (<500 copies/mL). Other infective serology and PCRs were also negative. MRI brain with gadolinium showed no abnormality.

The patient received supportive care and was neurologically normal within three months.

Conclusions ACA related to EBV is rare in adults. This report is important because it documents an adult case, other ACA causes have been rigorously excluded, resolution without antiviral therapy is detailed, and investigations support an immune-mediated pathogenesis.

References

  1. McCarthy CL, McColgan P, Martin P. Acute cerebellar ataxia due to Epstein-Barr virus. Pract Neurol 2012;12:238–240.

  2. Lascelles RG, Longson M, Johnson PJ, Chiang A. Infectious mononucleosis presenting as acute cerebellar syndrome. Lancet 1973;2:707.

https://doi.org/10.1136/jnnp-2019-anzan.37

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