Article: [Isolated neuritis of the oculomotor nerve in infectious mononucleosis]

A 19-year-old immune-competent patient developed right-sided headache and, subsequently, subacute diplopia. On clinical examination he had incomplete right oculomotor palsy. Cranial MRI showed pathologic contrast enhancement of the right oculomotor nerve at its exit point from the mesencephalon, and the CSF displayed slight pleocytosis. The following relevant differential diagnoses were not supported by additional examinations: neurosarcoidosis, Lyme neuroborreliosis, neurosyphilis, tuberculous meningitis, viral meningitis (HIV, VZV, CMV), CNS lymphoma, vasculitis associated with rheumatic disease, Tolosa-Hunt syndrome, and diabetic neuropathy. However, on the basis of blood lymphocytosis, positive heterophile antibody test (Paul-Bunnell test), the presence of IgM antibodies against Epstein-Barr virus capsid antigen, and elevated transaminases, infectious mononucleosis was diagnosed. Isolated neuritis of the oculomotor nerve is a rare parainfectious manifestation of infectious mononucleosis.

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References

1.

Watters M . Oculomotor palsy in infectious mononucleosis: case report. Mil Med. 1984; 149(1):33-4. View

2.

Rozen T, Zhou D, Allahyari P, Niknam R, Dougherty D, Morgan J . Miller Fisher syndrome: MRI findings. Neurology. 2001; 57(10):1755. DOI: 10.1212/wnl.57.10.1755. View

3.

Ishibashi A, Sueyoshi K, You M, Yokokura Y . MR findings in isolated oculomotor nerve palsy associated with infectious mononucleosis caused by Epstein-Barr virus infection. J Comput Assist Tomogr. 1998; 22(6):995-7. DOI: 10.1097/00004728-199811000-00029. View

4.

Bhatti M, Schmalfuss I, Eskin T . Isolated cranial nerve III palsy as the presenting manifestation of HIV-related large B-cell lymphoma: clinical, radiological and postmortem observations: report of a case and review of the literature. Surv Ophthalmol. 2005; 50(6):598-606. DOI: 10.1016/j.survophthal.2005.08.001. View

5.

Portegies P, Corssmit N . Epstein-Barr virus and the nervous system. Curr Opin Neurol. 2000; 13(3):301-4. DOI: 10.1097/00019052-200006000-00012. View

6.

NELLHAUS G . Isolated oculomotor nerve palsy in infectious mononucleosis. A report of an unusual case and review of the literature. Neurology. 1966; 16(2):221-4. DOI: 10.1212/wnl.16.2_part_1.221. View

7.

Kuppers R . B cells under influence: transformation of B cells by Epstein-Barr virus. Nat Rev Immunol. 2003; 3(10):801-12. DOI: 10.1038/nri1201. View

8.

Oksanen V, Gronhagen-Riska C, Tikanoja S, Somer H, Fyhrquist F . Cerebrospinal fluid lysozyme and beta 2-microglobulin in neurosarcoidosis. J Neurol Sci. 1986; 73(1):79-87. DOI: 10.1016/0022-510x(86)90066-3. View

9.

Connelly K, Dewitt L . Neurologic complications of infectious mononucleosis. Pediatr Neurol. 1994; 10(3):181-4. DOI: 10.1016/0887-8994(94)90021-3. View

10.

Candy B, Hotopf M . Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev. 2006; (3):CD004402. DOI: 10.1002/14651858.CD004402.pub2. View

11.

Schweisfurth H, Wernze H . Changes of serum angiotensin I converting enzyme in patients with viral hepatitis and liver cirrhosis. Acta Hepatogastroenterol (Stuttg). 1979; 26(3):207-10. View

[Isolated Neuritis of the Oculomotor Nerve in Infectious Mononucleosis]