{"id":184,"date":"2014-01-29T14:22:21","date_gmt":"2014-01-29T19:22:21","guid":{"rendered":"http:\/\/web.colby.edu\/bi265-humananatomyatcolby\/?p=184"},"modified":"2015-02-25T10:57:14","modified_gmt":"2015-02-25T15:57:14","slug":"grand-rounds-post-infectious-acute-cerebellar-ataxia","status":"publish","type":"post","link":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/2014\/01\/29\/grand-rounds-post-infectious-acute-cerebellar-ataxia\/","title":{"rendered":"Grand Rounds: Epstein-Barr Virus and Infectious Mononucleosis Induced Acute Post-infectious Cerebellar Ataxia"},"content":{"rendered":"

By: \u00a0Laurel W, Emma R, Peter W<\/p>\n

http:\/\/youtu.be\/iHSMb2sa8Dk<\/p>\n

One month before admission to Massachusetts General Hospital, a previously healthy 19 year old male presented with fatigue, fever, pharyngitis, and lymphadenopathy. A streptococcal pharyngitis (strep throat) test was found to be negative, and a heterophile antibody test (rapid test for mononucleosis) was found to be positive. The diagnosis of infectious mononucleosis due to Epstein-Barr virus (EBV) was made 17 days before admission.<\/p>\n

Two weeks prior to admission, the patient presented with additional symptoms, including dysphagia and pain and difficulty hearing in the right ear. A diagnosis of otitis media was made and was treated with prednisone, amoxicillin, and azithromycin. 8 days prior to admission, the patient presented with severe ear pain, a perforated right tympanic membrane, and a bloody purulent in the external auditory meatus. The patient was treated with oral cefurozime and ciprofloxacin (antibiotics). Several days after visiting the ENT, the patient returned for a myringotomy (procedure to relieve pressure in ear by making incision in ear drum). Then, 6 days prior to admission, the patient experienced unsteadiness, slurred speech, and increasing gait imbalance.<\/p>\n

Upon arrival the patient had experienced weight loss, decreased hearing, enlarged tonsils, falling, and truncal ataxia. Over the first four days of admission the patient was found to have opacification (indicating fluid in these areas) of right mastoid air cells and middle ear (as shown from MRI and CT scans), impaired ability to perform simple arithmetic, continued deterioration of speech, and balance. The CT scans of the cerebrum and cerebellum showed no abnormalities. The coordination test showed impairment in his motor functions. Slurred speech, clumsiness, ataxia (lack of coordination of movements) and otitis media led to the admission of the patient to neurology services.<\/p>\n

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Although Guillian-Barre syndrome is the most common cause of post-infectious ataxia, it is accompanied by loss of reflexes, which were intact in this case. Although cerebral involvement due to executive dysfunction was considered, it could not explain all of the patient\u2019s signs and symptoms. Hereditary and neurodegenerative diseases were ruled out due to lack of family history, normal imaging, and patient\u2019s age. However, the patient\u2019s symptoms, along with the diagnoses of infectious mononucleosis, led to the clinical diagnoses of an upper respiratory tract infection complicated by otitis media. The neurological symptoms also led to the diagnoses of post-infectious acute cerebellar ataxia (ACA) associated with Epstein-Barr virus. ACA is presumed to be an auto-immune response causing inflammation of the cerebellum leading to motor dysfunction.<\/p>\n

Plasmapheresis and intravenous immunoglobulin (IVIG) were recommended for treatment as this course is directed at the immune response and therefore more effective. IVIG is administering a solution containing antibodies from the plasma of thousands of people and Plasmapheresis is the process of removing, treating, and returning blood plasma to a patient. Both techniques are common treatments for autoimmune disorders. On the fourth day in Massachusetts General Hospital a five day course of IVIG was begun; the patient responded rapidly and his symptoms improved. After the fifth day of treatment the patient had recovered 90% of his function. He then spent one day in a rehabilitation center and was discharged on the eighth day after admission with a full recovery.
\nTracey A. Cho, M.D., Jeremy D. Schmahmann, M.D., and Mary E. Cunnane, M.D., et al. A 19-Year-Old Man with Otalgia, Slurred Speech, and Ataxia. N Engl J Med 2013;369:1253-1261<\/p>\n","protected":false},"excerpt":{"rendered":"

By: \u00a0Laurel W, Emma R, Peter W http:\/\/youtu.be\/iHSMb2sa8Dk One month before admission to Massachusetts General Hospital, a previously healthy 19 year old male presented with fatigue, fever, pharyngitis, and lymphadenopathy. A streptococcal pharyngitis (strep throat) test was found to be negative, and a heterophile antibody test (rapid test for mononucleosis) was found to be positive. […]<\/p>\n","protected":false},"author":5245,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0,"footnotes":""},"categories":[145196],"tags":[145212,145215,145216],"_links":{"self":[{"href":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/wp-json\/wp\/v2\/posts\/184"}],"collection":[{"href":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/wp-json\/wp\/v2\/users\/5245"}],"replies":[{"embeddable":true,"href":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/wp-json\/wp\/v2\/comments?post=184"}],"version-history":[{"count":3,"href":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/wp-json\/wp\/v2\/posts\/184\/revisions"}],"predecessor-version":[{"id":229,"href":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/wp-json\/wp\/v2\/posts\/184\/revisions\/229"}],"wp:attachment":[{"href":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/wp-json\/wp\/v2\/media?parent=184"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/wp-json\/wp\/v2\/categories?post=184"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/web.colby.edu\/bi265-humananatomyatcolby\/wp-json\/wp\/v2\/tags?post=184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}