Deep tendon reflexes may initially be decreased, but usually are increased with Babinski signs present. Cerebellar dysfunction is common and initially may be the only finding. Laboratory evaluation typically shows a CSF pleocytosis with up to 150-200 WBCs, generally with a lymphocytic predominance. Radiological evaluation is quite helpful. While the CT scan is generally normal, MRI images show multiple white matter lesions on T2 and flair sequences with gadolinium enhancement on T1.
Treatment is aimed at suppressing the immune response.
Plasma exchange and IV IG have been used with reported good benefit, but it is unclear if these therapies are more successful than steroid use. More aggressive immunosuppressive therapy with intravenous cytoxan is advocated by a few individuals, but there are no clear guidelines for its use. The decision to use steroids or chemotherapy is therefore empirical at this point. The prognosis is variable.