Primary Epstein–Barr-Virus Infections in Acute Neurologic Diseases

Abstract

Infectious mononucleosis has been associated with Guillain—Barré Syndrome, Bell's palsy, meningoencephalitis and transverse myelitis. Since it is now known that many children with infectious mononucleosis do not develop heterophil antibodies, we looked for evidence of current or recent Epstein-Barr Virus infection in young patients with these neurologic diseases by using serodiagnostic procedures for detection and titration of antibodies to various antigens related to Epstein-Barr virus. Seven of 24 cases with Guillain-Barré syndrome and three of 16 with facial palsy were definitely associated with primary infection with Epstein-Barr virus as were two cases each of the other two neurologic diseases. Only one of these patients had obvious clinical infectious mononucleosis, and only a few demonstrated heterophil agglutinins. It is evident that the virus must be considered in the diagnosis of various acute neurologic diseases affecting children and young adults, even in the absence of a heterophil-antibody response or other signs of infectious mononucleosis. (N Engl J Med 292:392–395, 1975)