Epstein-Barr virus encephalitis

Last revised by Yusra Sheikh on 2 Jul 2020

Epstein-Barr virus (EBV) encephalitis is an uncommon manifestation of EBV infection and an uncommon causative organism of encephalitis in general.

Most reported cases have been in children, although adults can rarely be affected 5.

Primary EBV infection is usually asymptomatic or manifests as infectious mononucleosis with fever, lymphadenopathy and tonsillopharyngitis 1. EBV encephalitis presents non-specifically with the following 1:

  • fever
  • headache
  • seizures
  • altered level of consciousness
  • symptoms of infectious mononucleosis usually being absent

The median time between the onset of prodromal features and neurological symptoms is 7 days 1. Other signs of EBV infection (e.g. myocarditis) may be present in some patients.

Around 5% of viral encephalitis are due to EBV infection 2. Direct viral invasion and a secondary autoimmune response directed against the brain is thought to cause the symptoms and imaging findings 3. A variety of other neurological manifestations from EBV infection have also been described including myelitis, polyradiculitis, polyradiculomyelitis and acute cerebellar ataxia 4.

In one study 71% of pediatric patients with EBV encephalitis had an abnormal MRI 1. The following is the typical pattern observed 6:

  • T2/FLAIR:
    • multifocal areas of hyperintensity
    • present mainly within the sub-cortical white matter and deep grey nuclei
  • DWI: high diffusion signal

Antivirals (e.g. acyclovir) are recommended 7. Symptomatic treatment of seizures and respiratory support may be needed. Although most patients survive lasting neurological deficit and death are not uncommon 1,3

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