Infectious Mononucleosis With Diffuse Involvement of Nervous System

Abstract

ALTHOUGH infectious mononucleosis was first described by Pfeiffer1 in 1889, it was not until 1931 that its manifestations referable to the nervous system were recognized.2 Since then at least 36 reports, describing 54 patients, have appeared on this unusual manifestation of the infection. The following case of infectious mononucleosis with involvement of the central nervous system presents unusual clinical findings, and for the first time a positive result of a quantitative heterophile agglutination test on the cerebrospinal fluid is reported. Electroencephalographic tracings taken during the course of acute illness are also demonstrated. REPORT OF CASEAn airman aged 21, white, had an infection of the upper respiratory tract on March 31, 1952. Four days later there developed recurrent frontal headaches, which were most severe during the morning. Thereafter he noted easy fatigability, malaise, and lethargy. On the evening of April 9 he had a severe chill, followed by profuse diaphoresis, and on the following day he was extremely lethargic and vomited several times. During the day he seemed to be some¬ what irrational. That evening he had an episode of twitching of the left side of the face and

Fatal Encephalopathy in Glandular Fever

“…The contrary may also be found and the typical features of glandular fever run their course and subside before neurological features develop (Sucher and Schwarz, 1936;Geliebter, 1946;Silversides and Richardson, 1950;Freedman et al, 1953;Green, 1955). It should also be noted that in other cases, even when the illness has progressed to the stage of deep coma and extensor spasms, recovery has been spontaneous (Walsh et al, 1954).…”

“…An account of these varied neurological manifestations of the condition has been provided by Kissel, Arnould, and Leval (1952). Landes, Reich, and Perlow (1941) referred to a dozen cases in the literature; Bernstein and Wolff (1950) reviewed 34 published cases; Silversides and Richardson (1950) collected 59; Freedman, Odland, and Cleve (1953) found 54 cases and Leibowitz (1953) reviewed 71 in his monograph on glandular fever; Walsh, Poser, and Carter (1954) spoke of approximately 100 cases in the literature.…”

“…These authors refer to a case previously published by Landes et al (1941) in which giddiness, unsteadiness, and acute ataxia were present although no attempt was made to localize the responsible lesion. In the case of Freedman et al (1953) there was difficulty in coordinating movements of the limbs during the convalescent phase. Seltzer (1953) described a case with ataxia of cerebellar origin although the patient had polyneuritic features in addition.…”