INVOLVEMENT OF THE NERVOUS SYSTEM IN INFECTIOUS MONONUCLEOSIS
Authors: T C BERNSTEIN, H G WOLFF
Journal: Annals of Internal Medicine (1950)

Article1 November 1950INVOLVEMENT OF THE NERVOUS SYSTEM IN INFECTIOUS MONONUCLEOSISTHEODORE C. BERNSTEIN, M.D., HAROLD G. WOLFF, M.D., F.A.C.P.THEODORE C. BERNSTEIN, M.D., HAROLD G. WOLFF, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-33-5-1120 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough involvement of the nervous system in patients with infectious mononucleosis has been described frequently during the past few years, its incidence has not been defined precisely. It is possible that some of the "idiopathic" acute disorders of the nervous system may be associated with infectious mononucleosis.† It seems pertinent, therefore, to consider the variety and phenomenology of such nervous system manifestations and to report a patient with meningo-encephalitis associated with infectious mononucleosis studied at the Bronx Veterans Hospital.Cases cited from the literature have been classified as to symptom complex. In order to do this, certain criteria were arbitrarily...Bibliography1. Johansen AJ: Serous meningitis and infectious mononucleosis, Acta med. Scandinav. 76: 269, 1931. CrossrefGoogle Scholar2. EpsteinDameshek SHW: Involvement of the central nervous system in a case of glandular fever, New England J. Med. 205: 1238, 1931. CrossrefGoogle Scholar3. Fledelius M: Augenmusskelamung als Komplikation der Mononucleosis infectiosa, Acta ophth. 13: 150, 1935. CrossrefGoogle Scholar4. SucherSchwarz AE: Lymphatische Reaktion und Encephalomeningitis, Wien. klin. Wchnschr. 49: 1417, 1936. Google Scholar5. Gsell O: Meningitis serosa bei Pfeifferschem Drusenfieber (Mononucleosis infectiosa), Deutsche med. Wchnschr. 63: 1759, 1937. CrossrefGoogle Scholar6. Davidsohn I: Serologic diagnosis of infectious mononucleosis, J. A. M. A. 108: 289, 1937. CrossrefGoogle Scholar7. Huber EA: Serous Meningitis in Pfeifferschem Drusenfieber, Schweiz. med. Wchnschr. 68: 882, 1938. Google Scholar8. SchmidtNyfeldt VA: Regarding infectious mononucleosis and meningoencephalitis, Acta oto-laryng. 26: 680, 1938. CrossrefGoogle Scholar9. Pietzonka H: Meningitis serosa bei Pfeifferschem Drusenfieber, Deutsch. Arch. f. klin. Med. 185: 153, 1939. Google Scholar10. ThomsonVimtrup SB: Six fatal cases of infectious mononucleosis complicated by central respiratory paralysis, Nord. med. 4: 3295, 1939. Google Scholar11. Marshall EA: Infectious mononucleosis, Am. J. Clin. Path. 9: 298, 1939. CrossrefGoogle Scholar12. ThelanderShaw HEEB: Infectious mononucleosis with special reference to cerebral complications, Am. J. Dis. Child. 61: 1131, 1941. CrossrefGoogle Scholar13. LandesReichPerlow RJPS: Central nervous system manifestations of infectious mononucleosis, J. A. M. A. 116: 2482, 1941. CrossrefGoogle Scholar14. LeavellMcNeel BSJO: Infectious mononucleosis: unusual manifestations, Virginia M. Monthly 69: 180, 1942. Google Scholar15. ZohmanSilverman BLEG: Infectious mononucleosis and encephalomyelitis, Ann. Int. Med. 16: 1233, 1942. LinkGoogle Scholar16. Richardson JS: Serratus magnus palsy, Lancet 1: 618, 1942. CrossrefGoogle Scholar17. HillerFox RIMJ: Infectious neuronitis associated with infectious mononucleosis, Marquette M. Rev. 7: 152, 1943. Google Scholar18. ShaferWeir JJR: Meningeal reaction in a case of glandular fever, Brit. M. J. 1: 218, 1943. CrossrefMedlineGoogle Scholar19. Saksena HC: Paralysis of the serratus anterior following glandular fever, Brit. M. J. 2: 267, 1943. CrossrefMedlineGoogle Scholar20. Solomons B: Infectious mononucleosis: meningeal features, J. Roy. Nav. M. Serv. 31: 178, 1945. CrossrefGoogle Scholar21. CooganMartinsonMathews TSDLWH: Infectious mononucleosis: neurological symptoms, Illinois M. J. 87: 296, 1945. Google Scholar22. WechslerRosenblumSills HFAHCT: Infectious mononucleosis: report of an epidemic in an army post, Ann. Int. Med. 25: 256, 1946. Google Scholar23. Geliebter S: Acute infectious mononucleosis complicated by encephalomyelitis, Lancet 2: 753, 1946. CrossrefMedlineGoogle Scholar24. VaughnReganTerplan SLJSK: Infectious mononucleosis complicated by spontaneous rupture of the spleen and central nervous system involvement, Blood 1: 335, 1946. Google Scholar25. Slade J: Involvement of the central nervous system in infectious mononucleosis, New England J. Med. 234: 753, 1946. CrossrefMedlineGoogle Scholar26. SchneiderMichaelson TDA: Central system manifestations of glandular fever, South African M. J. 21: 57, 1947. MedlineGoogle Scholar27. RickerBlumbergPetersWiderman WACHA: The association of the Guillain-Barré syndrome with infectious mononucleosis, Blood 2: 217, 1947. CrossrefMedlineGoogle Scholar28. AshworthMotto JS: Infectious mononucleosis complicated by bilateral papilloretinal edema, New England J. Med. 237: 544, 1947. CrossrefMedlineGoogle Scholar29. MurrayWebbSwann EGRAMB: Disease of rabbits characterized by large mononuclear leukocytes, J. Path. and Bact. 29: 407, 1926. CrossrefGoogle Scholar30. Nyfeldt A: Etiologie de la mononucleose infectieuse, Compt. rend. Soc. de biol. 33: 218, 1935. Google Scholar31. Bland JO: Glandular fever: experimental investigation, Lancet 2: 521, 1930. CrossrefGoogle Scholar32. Van den BerghLiessens LP: Transmission de la mononucleose infectieuse humanine au Macacus rhesus, Compt. rend. Soc. de biol. 132: 90, 1939. Google Scholar33. JulianelleBierbaumMoore LAOSCV: Studies on infectious mononucleosis, Ann. Int. Med. 20: 281, 1944. LinkGoogle Scholar34. BurnetAnderson FMSG: Modification of human red cells by virus action. II. Agglutination of modified human red cells by sera from cases of infectious mononucleosis, Brit. J. Exper. Path. 27: 236, 1946. MedlineGoogle Scholar35. DowneyStasney HJ: The pathology of lymph nodes in infectious mononucleosis, Folia haemat. 54: 417, 1935-6. Google Scholar36. GallStout EAHA: Histological lesions in lymph nodes in infectious mononucleosis, Am. J. Path. 16: 443, 1940. Google Scholar37. AllenKellner FHA: Infectious mononucleosis, Am. J. Path. 23: 463, 1947. MedlineGoogle Scholar38. Gorham LW: Infectious mononucleosis (from Cecil's Textbook of medicine), 1947, W. B. Saunders and Company, Philadelphia, p. 515. Google Scholar39. Milne J: Infectious mononucleosis, New England J. Med. 233: 727, 1945. CrossrefMedlineGoogle Scholar40. Collins-WilliamsFerguson CTCC: Infectious mononucleosis, Canad. M. A. J. 55: 17, 1946. Google Scholar41. HalcrowOwenRoger JPLMNO: Infectious mononucleosis: report of an epidemic, Brit. M. J. 2: 443, 1943. CrossrefMedlineGoogle Scholar42. Tidy HL: Relationship of benign lymphocytic meningitis and glandular fever, Lancet 2: 819, 1946. CrossrefMedlineGoogle Scholar43. Wesselhoeft C: Medical progress (mumps), New England J. Med. 226: 530, 1942. CrossrefGoogle Scholar44. de LavergneKisselAccoyer VPH: Étude sur la periode d'incubation des "oreillons," Bull. Acad. de méd., Paris 119: 534, 1938. Google Scholar45. Lightwood : Myelitis from mumps, Brit. M. J. 1: 484, 1946. CrossrefGoogle Scholar46. BonninBergouignan HA: Infectious mononucleosis with curable meningoencephalitis and temporary coma, Bull. et mém. Soc. méd. d. hôp. de Paris 64: 39, 1948. Google Scholar47. Field WW: Severe central nervous system involvement in infectious mononucleosis, Am. J. Med. 4: 154, 1948. CrossrefMedlineGoogle Scholar48. Payn SB: Virus meningitis and infectious mononucleosis, N. Y. State J. Med. 48: 631, 1948. MedlineGoogle Scholar49. RaymondWilliams RWRL: Infectious mononucleosis with psychosis, N. Eng. J. Med. 239: 542, 1948. CrossrefMedlineGoogle Scholar50. de Vita P: Meningoradiculitis due to infectious mononucleosis, Gior. di clin. med. 29: 593, 1948. MedlineGoogle Scholar51. BickelMachdella SantaDucommun GRRP: Neurologic forms of mononucleosis, Schweiz. med. Wchnschr. 78: 938, 1948. MedlineGoogle Scholar52. KarpeWising GP: Infectious mononucleosis. Retinal changes with acute reduction of vision as the initial symptom, Acta ophth. 26: 19, 1948. CrossrefGoogle Scholar53. Bercel NA: The electro-encephalogram in cerebral complications of infectious mononucleosis, J. Nerv. and Ment. Dis. 107: 537, 1948. CrossrefMedlineGoogle Scholar54. DolgopolHusson VBGS: Infectious mononucleosis with neurologic complications, Arch. Int Med. 83: 179, 1949. CrossrefGoogle Scholar55. Bickel G: Les formes nerveuses et ménengées de l'angine à monocytes et de la mononucleose infectieuse, Pract. otorhinolar. 11: 79, 1949. MedlineGoogle Scholar56. GrahamSchwartzChapman SDWHWL: Infectious neuronitis complicating infectious mononucleosis, U. S. Nav. Med. Bull. 49: 914, 1949. MedlineGoogle Scholar57. HaymakerKernohan WJW: The Landry-Guillain-Barré syndrome, Medicine 28: 59, 1949. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, N. Y.*Received for publication December 4, 1948.From the Department of Neurology, Veterans Administration Hospital, Bronx, New York City. Published with permission of the Chief Medical Director, Department of Medicine and Surgery of the Veterans Administration, who assumes no responsibility for the opinions expressed or the conclusions drawn by the authors.†First described in 1889 by E. Pfeiffer, in 1920 by Sprunt and Evans, and established as an entity by Tidy and Morley in 1921, and by Glanzman in 1930.38‡"Paul-Bunnell test" (1932)—significant in dilutions above 1 : 64.38§The red blood count and hemoglobin are within normal limits. There is a leukopenia early in the course of the disease, followed by a normal count or a leukocytosis. The differential count shows a marked increase in lymphocytes. Although there are several types of atypical cells, the classical one is about the size of a normal lymphocyte, with a lobulated nucleus containing chromatin in the form of a coarse network of heavy strands. The cytoplasm is basophilic and has a vacuolated foamy appearance. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMollaret's Meningitis: A Rare EntityEpstein-Barr virus infection in the development of neurological disordersEpstein-Barr Virus (Infectious Mononucleosis, Epstein-Barr Virus–Associated Malignant Diseases, and Other Diseases)Epstein–Barr virus infections of the nervous systemEpstein–Barr Virus and Cytomegalovirus InfectionsEpstein-Barr Virus (Infectious Mononucleosis, Epstein-Barr Virus–Associated Malignant Diseases, and Other Diseases)Hemorrhagic encephalitis associated with Epstein-Barr virus infectionEPSTEIN-BARR VIRUSEpstein-Barr virus acute encephalomyelitis in a 13-year-old boyBasal ganglia and brainstem encephalitis, optic neuritis, and radiculomyelitis in Epstein–Barr virus infectionPediatric Epstein-Barr Virus—Associated Encephalitis: 10-Year ReviewEpstein–Barr Virus and the Nervous SystemEpstein-Barr Virus and the Nervous SystemPersistent Preceding Focal Neurologic Deficits in Children With Chronic Epstein-Barr Virus EncephalitisAcute manifestations and neurologic sequelae of Epstein-Barr virus encephalitis in childrenA syndrome of concurrent central and peripheral nervous system involvement due to Epstein-Barr virus infectionDiagnosis of Epstein-Barr virus-induced central nervous system infections by DNA amplification from cerebrospinal fluidNeurologic complications of infectious mononucleosisCorrespondenceDetection of Epstein-Barr virus in the brain by the polymerase chain reactionThe Association of Epstein-Barr Virus with Lymphoproliferative Disorders: A Re-evaluation Using the Polymerase Chain ReactionReply to comment byA. Lopez-Navidad andP. Domingo on unusual manifestations of epstein-barr virus (EBV) encephalomyelitis (infection 18, 1990, 33–35)Ocular disease associated with Epstein-Barr virus infectionNeurologic Complications of Infectious MononucleosisAtypical PresentationsRole of the virology laboratory in diagnosis and management of patients with central nervous system diseaseGuillain-barré syndrome and other neurologic syndromes in hepatitis A, B, and non-A, non-BInfectious Mononucleosis and Psychiatric DisordersEpstein-Barr Virus Antibodies in Neurological DiseasesCase 29-1984Isolated abducens nerve palsy preceding infectious mononucleosisSchizophreniform psychosis with infectious mononucleosisTransient global amnesia as a manifestation of Epstein-Barr virus encephalitisVirale Krankheiten im HNO-BereichPeriodic EEG complexes in infectious mononucleosis encephalitis.The Neurology of Affective Disorder and SuicideUpper Airway Obstruction in Infectious MononucleosisAn isolated right hypoglossal nerve palsy in association with infectious mononucleosisBilateral sixth cranial nerve palsy in infectious mononucleosisCytomegalovirus infection of the adult nervous systemAcute facial palsy: Some Clinical and Virological ObservationsAcute Facial Palsy: Some Clinical and Virological ObservationsPrimary Epstein–Barr-Virus Infections in Acute Neurologic DiseasesDie infektiöse MononucleoseInfectious mononucleosis with acute urinary retentionINFECTIOUS MONONUCLEOSIS PRESENTING AS ACUTE CEREBELLAR SYNDROMESpontaneous Cytomegalovirus Mononucleosis Clinical and Laboratory Observations in Nine CasesM. COLIN JORDAN, M.D., WYATT E. ROUSSEAU, M.D., JOHN A. STEWART, M.D., GARY R. NOBLE, M.D., TOM D. Y. CHIN, M.D.EPSTEIN-BARR VIRUS AND GUILLAIN-BARRE SYNDROMEFocal Encephalomyelitis in Infectious Mononucleosis A Report with Pathological DescriptionMARY AMBLER, M.D., JULIUS STOLL, M.D., ANTONIOS TZAMALOUKAS, M.D., MAURICE M. ALBALA, M.D., F.A.C.P.A Case of infectious mononucleosis presenting with a bilateral facial palsyThe Long-Term Prognosis of Aseptic Meningitis in ChildhoodSerumenzyme bei der Mononucleosis infektiosa im KindesalterSuspected Epstein–Barr Virus (EBV) Disease of the Anterior SegmentMeningoencephalomyelitiden und Encephalopathien mit fakultativem oder fehlendem VirusnachweisMononucleosis infectiosa (Pfeiffer'sches Drüsenfieber)Mononucleosis infectiosa (Pfeiffer'sches Drüsenfieber)Infectious MononucleosisREFERENCESNEUROLOGICAL COMPLICATIONS OF MONONUCLEOSISViral EncephalitisAcute Cerebellar Syndrome Secondary to Infectious Mononucleosis in a Fifty-two Year Old ManDONALD R. BENNETT, HENRY A. PETERS, M.D., F.A.C.P.Facial Diplegia in Infectious Mononucleosis in the Absence of Landry-Guillain-Barrù SyndromeFATAL ENCEPHALOPATHY IN GLANDULAR FEVERThe treatment of infectious mononucleosisChronic "benign aseptic meningitis"Nonbacterial Infections Affecting the NasopharynxSeizures in infectious mononucleosisOcular Symptoms in Glandular FeverInfectious Mononucleosis: Some Considerations in Diagnosis and TreatmentCOMPLICATIONS OF INFECTIOUS MONONUCLEOSIS*JASON NED SMITH JR., M.D.Infectious mononucleosis of the central nervous systemThe Guillain–Barre Syndrome as a Manifestation of Infectious MononucleosisMononucleosis, Guillain-Barré Syndrome and Paralysis of the Posterior Crico-Arytenoid MuscleINFECTIOUS MONONUCLEOSIS ENCEPHALITIS: CASE REPORT*CHARLES R. REAM, M.D., JOHN W. HESSING, M.D.Beiträge zum Problem der Infektiösen MononukleoseASEPTIC MENINGITIS, A DISEASE OF DIVERSE ETIOLOGY: CLINICAL AND ETIOLOGIC STUDIES ON 854 CASES*CHARLES V. ADAIR, ROSS L. GAULD, M.D., JOSEPH E. SMADEL, M.D.Coma in Infectious MononucleosisThe Diagnosis and Treatment of Polyneuritic Syndromes "Multiple Peripheral Neuritis"Peripheral Neuropathy and Serous Meningitis Due to Horse SerumInfectious mononucleosis 1 November 1950Volume 33, Issue 5Page: 1120-1138KeywordsBlood countsCellsChromatinCytoplasmHemoglobinLeukocytosisLymphocytesNervous systemNeurologySurgery ePublished: 1 December 2008 Issue Published: 1 November 1950 PDF downloadLoading ...