Acta Ophthalmologica 2015
Letter to the Editor Isolated oculomotor nerve palsy revealing infectious mononucleosis Ariane Malcles, Solene Ronsin, Emilie Agard, Lucie Abouaf, Caroline Tilikete, Alain Vighetto and Damien Biotti Neuro-Ophthalmology Unit, Lyon Civil Hospitals, Neurological Hospital, Lyon 1 University, Bron Cedex, France doi: 10.1111/aos.12636
Editor, pstein–Barr virus (EBV) is a member of the herpesvirus family causing infectious mononucleosis (IM). Neurological complications have been reported rarely. A previously healthy 18-year-old woman presented with a 5-day history of binocular vertical diplopia, asthenia and night sweats. Ophthalmological examination was normal. Pupils were equal and reactive to light, with no relative afferent pupillary defect. Oculomotor examination revealed a left pupil sparing partial third nerve palsy (partial ptosis and moderate restriction of elevation, depression and adduction). The rest of the neurological examination was unremarkable. General examination revealed an apyretic patient with painless disseminated lymph nodes and a mild hepatomegaly. Brain MRI showed a focal T2 abnormal hyperintense signal located on the left oculomotor nerve at its exit from the mesencephalon. A gadolinium enhancement was noted (Fig. 1). Biochemistry abnormalities showed hepatic cytolysis (ASAT/ALAT 3ULN) and C-reactive protein level of 13.5 mg/l. IgM and IgG antibodies against Epstein–Barr viral capsid antigen were found positive, whereas IgG antibodies for Epstein–Barr nuclear antigen were negative. Epstein–Barr viral load testing by PCR reached 65 000 copies/ml. This biological profile was indicative of an acute primary EBV infection. Diplopia gradually resolved in a few days, followed in several weeks by the
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resolution of asthenia and lymphadenopathy. At the 2-month follow-up visit, neuro-ophthalmological examination and liver enzymes level had return to normal. A new brain MRI showed the decrease in size of the previously noted hyperintense signal of the left oculomotor nerve, with mild residual gadolinium enhancement. Peripheral and/or central nervous system (CNS) involvement is rare in IM, occurring in
Letter to the Editor Isolated oculomotor nerve palsy revealing infectious mononucleosis Ariane Malcles, Solene Ronsin, Emilie Agard, Lucie Abouaf, Caroline Tilikete, Alain Vighetto and Damien Biotti Neuro-Ophthalmology Unit, Lyon Civil Hospitals, Neurological Hospital, Lyon 1 University, Bron Cedex, France doi: 10.1111/aos.12636
Editor, pstein–Barr virus (EBV) is a member of the herpesvirus family causing infectious mononucleosis (IM). Neurological complications have been reported rarely. A previously healthy 18-year-old woman presented with a 5-day history of binocular vertical diplopia, asthenia and night sweats. Ophthalmological examination was normal. Pupils were equal and reactive to light, with no relative afferent pupillary defect. Oculomotor examination revealed a left pupil sparing partial third nerve palsy (partial ptosis and moderate restriction of elevation, depression and adduction). The rest of the neurological examination was unremarkable. General examination revealed an apyretic patient with painless disseminated lymph nodes and a mild hepatomegaly. Brain MRI showed a focal T2 abnormal hyperintense signal located on the left oculomotor nerve at its exit from the mesencephalon. A gadolinium enhancement was noted (Fig. 1). Biochemistry abnormalities showed hepatic cytolysis (ASAT/ALAT 3ULN) and C-reactive protein level of 13.5 mg/l. IgM and IgG antibodies against Epstein–Barr viral capsid antigen were found positive, whereas IgG antibodies for Epstein–Barr nuclear antigen were negative. Epstein–Barr viral load testing by PCR reached 65 000 copies/ml. This biological profile was indicative of an acute primary EBV infection. Diplopia gradually resolved in a few days, followed in several weeks by the
E
resolution of asthenia and lymphadenopathy. At the 2-month follow-up visit, neuro-ophthalmological examination and liver enzymes level had return to normal. A new brain MRI showed the decrease in size of the previously noted hyperintense signal of the left oculomotor nerve, with mild residual gadolinium enhancement. Peripheral and/or central nervous system (CNS) involvement is rare in IM, occurring in
