Carotid Artery Thrombosis, Encephalitis, Myelitis and Optic Neuritis Associated With Rubella Virus Infections

Abstract

The clinical, virological and pathological findings in 5 patients with neurological complications associated with rubella virus infection are described. The neurological illnesses began four to ten days after the rubella illnesses. The patients were all males aged between 6 and 17 years and were diagnosed during one non-epidemic year in a population of 1-5 million people. All the patients had rubella specific IgM in their sera. Two patients had no rash. In one of the patients who died, left internal carotid artery thrombosis and cerebral infarction were found at post-mortem. Rubella virus antigen and particles resembling rubella virus were found in the brain together with IgG and IgM in the same areas. This patient also had extensive liver necrosis. The other patient had a severe meningomyelitis and radiculitis and he recovered completely after two years. His serum rubella antibody rose significantly and was shown to leak into CSF during the acute stage of his illness. Three patients had a rash. Two of these patients had encephalitis: one recovered completely and the other had residual disability. The third patient had bilateral optic neuritis from which he recovered completely. Rubella specific IgM was, however, present in his serum for the abnormally long time of twenty-eight weeks indicating possible persistence of rubella virus.

Postinfectious Encephalomyelitis

“…During the week after onset of rash, fever, depression of consciousness, and seizures are seen, but they are usually without focal neurologic ~i~n s .~, ' * , '~ Transverse myelitis and polyradiculitis also have been reported. 77 In the majority of fatal cases, neither perivenular demyelination nor inflammation has been found. Typical pathologic features of postinfectious encephalomyelitis are rare.…”

Relapsing neurological disorder associated with rubella virus infection in two sisters.

“…So far, 118 patients with neurological complications of rubella have been reported. In addition to encephalitis, complications include myelitis (Morris and Robbins, 1943), radiculitis, optic neuritis, and cerebral arterial thrombosis (Connelly et al, 1975). Diffuse myelitis has also been described after rubella vaccination (Holt et al, 1976).…”

“…An increase in the serum levels of rubella specific IgM indicates active antigenic stimulation by the rubella virus, as a result of a persistent infection. This investigation is of particular value in the diagnosis of rubella infection in the absence of a rash, especially as neurological complications due to rubella are not always associated with a rubella rash (Connelly et al, 1975).…”

Electromyographic evaluation of blink reflex as a tool for early diagnosis of neurological dysfunction in patients of hypothyroidism.

“…The latencies of the reflex responses were measured from the stimulus artifact to the initial deflection of the potential. 14 For each subject, at least 10 recordings were obtained to get the shortest latency time R1 and R2 responses. A mplitude was considered an unreliable index and will not be used in any analysis.…”