A Case of Epstein-Barr Virus-associated Brainstem Encephalitis Presenting with Sixth Cranial Nerve Palsy in a Child

Epstein - Barr virus 간염과 동반된 6번 뇌신경 마비 증상을 보인 뇌간 뇌염 1례

EBV 감염은 다양한 신경계 합병증을 일으키는 것으로 보고되고 있다. 뇌간뇌염은 EBV에 의해 발생하는 신경계 합병증 중 드문 증상이다. 전염성 단핵구증의 증상이나 증후 없이 6번 뇌신경 마비 중상인 안구 운동 마비를 보인 EBV감염과 동반된 뇌간 뇌염에서 prednisolone 투여 후 호전된 1례를 경험 하였기에 문헌고찰과 함께 보고하는 바이다.

Brainstem encephalitis caused by Epstein-Barr virus (EBV) is rare in childhood. We describe a 14-month-old-boy who presented with limitation of eye movements with sixth cranial nerve palsy. Brainstem encephalitis caused by EBV was diagnosed, based on the neuroimaging and cerebrospinal fluid (CSF), serological examination for EBV infection. Brain magnetic resonance imaging (MRI) showed high signal intensity in T2 and low signal intensity in T1 in both pons and medulla. The result of EBV polymerase chain reaction (PCR) of the CSF was positive, and a serological test showed a convalescent phase of primary infection: positive for viral capsid antigen (VCA)-IgM, VCA-IgG and EBV nuclear antigen (EBNA)-IgG, negative for heterophil antibody. We suggest that EBV infection should be considered a differential diagnosis cause of pediatric brainstem encephalitis and emphasizes the need for immediate diagnosis and initiation of symptomatic and specific therapy.