Acute manifestations and neurologic sequelae of Epstein-Barr virus encephalitis in children

Pediatr Infect Dis J. 1996 Oct;15(10):871-5. doi: 10.1097/00006454-199610000-00008.


Background: Complications of Epstein-Barr virus (EBV) infection are diverse and include a number of neurologic manifestations such as meningitis, meningoencephalitis, cerebellitis, cranial neuritis and others. In general encephalitis caused by EBV in pediatric patients has been considered a self-limited illness with few or no sequelae.

Methods: Charts were reviewed from all patients < 18 years of age admitted to or discharged from the State University of New York Health Science Center at Syracuse between 1982 and 1992 with a diagnosis of encephalitis or meningo-encephalitis. Eleven cases of EBV encephalitis diagnosed during a 10-year period were reviewed to characterize the clinical and laboratory findings in the acute setting and the extent of neurologic sequelae on follow-up.

Results: Acute neurologic manifestations were diverse and included combative behavior (55%), seizures (36%), headache (36%) and evidence of focal involvement (27%). Classic findings of infectious mononucleosis were noted infrequently; 18% each had pharyngitis, adenopathy, positive heterophile antibody tests or atypical lymphocytosis. Two patients (18%) had abnormal neuroimaging studies, one in the acute stage and the other at the time of follow-up. Seven patients (64%) had abnormal electroencephalograms (EEGs) in the acute setting; of these three had persistent abnormalities on follow-up. Forty percent developed persistent neurologic abnormalities including global impairment, perseverative autistic-like behavior and persistent left upper extremity paresis.

Conclusions: Classic signs, symptoms and laboratory findings in infectious mononucleosis may be absent in Epstein-Barr virus encephalitis. Neurologic sequelae occur in a substantial number of patients.

MeSH terms

  • Acute Disease
  • Adolescent
  • Child
  • Child, Preschool
  • Electroencephalography
  • Encephalitis, Viral / diagnosis*
  • Encephalitis, Viral / etiology
  • Female
  • Herpesvirus 4, Human / isolation & purification
  • Humans
  • Infectious Mononucleosis / complications*
  • Infectious Mononucleosis / diagnosis
  • Male
  • Meningoencephalitis / diagnosis
  • Meningoencephalitis / virology
  • Serologic Tests