Epstein-Barr virus encephalitis

Case contributed by Dr Lander Antón

Presentation

Admitted in the emergency department for a 24 hour-long intermittent and progressive loss of consciousness. The patient arrived to the same E.D. 5 days previously with a febrile syndrome, and was diagnosed with an Epstein-Barr infection (positive Paul-Bunnell test). Fever remitted before the current symptoms began.

Patient Data

Age: 15 years
Gender: Male

Brain CT at admission time

CT

Bilateral and symmetric hypodensity and swelling of caudate heads and hippocampi. Partial effacement of lentiform nuclei caused by a bilateral symmetric hypodensity in both internal and external capsules.

Brain MRI 1 day later

MRI

Frontobasal artifact caused by orthodontic device.

Bilateral, symmetrical swelling and T2-FLAIR hyperintensity of caudate heads, lentiform nuclei, claustra, hippocampi and frontotemporal gyri.

Associated restricted diffusion in claustra, posterior lentiform nuclei and subcortical frontotemporal white matter.

Case Discussion

The findings are consistent with EBV encephalitis.

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