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Epstein-Barr Virus Cerebellitis Presenting as Obstructive Hydrocephalus

Ce entral nervous system involvement with EpsteinBarr virus (EBV) is probably more common than generally recognized. Significant neurologic complications are rare and occurred in only 0.5% of more than 4,300 cases in one review.' Symptoms can develop shortly before, during, or after infectious mononucleosis . The neurologic complications of EBV are diverse and include meningitis, meningoencephalitis, cerebellitis, cranial neuritis, and others.2 Classic symptoms of mononucleosis are often absent in EBV encephalitis and cerebellitis. The virus presumably enters the central nervous system by trafficking of infected lymphocytes. The virus has rarely been cultured from cerebrospinal fluid. Epstein-Barr virus DNA was found in a series of five cases diagnosed as having infectious mononucleosis with other serologic methods. These children had evidence of encephalitis and the DNA polymerase chain reaction became negative after recovery.3 While EBV encephalitis may involve any area of the brain, the cerebellum is frequently involved. There have been several case reports of EBV cerebellitis presenting as acute ataxia.4 A number of viruses (such as varicella-Zoster, EBV, Coxsakie virus and echo virus) are known to have a predilection for the cerebellum. A few cases of acute cerebellar swelling resulting in tonsillar herniation and death in EBV cerebellitis have been reported.5 We report a 15-year-old girl in whom bilateral acute cerebellitis and obstructive hydrocephalus with rapid changes in mental status developed after viral meningitis.