NEUROLOGICAL COMPLICATIONS OF MONONUCLEOSIS

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Abstract
In mononucleosis, neurological complications are certainly more common than can be inferred from the medical literature. A survey has been made of published cases with various neurological findings in the history. As in meningitis and encephalo-myelitis, the central or peripheral nervous system, or both, may be involved. Encephalitis with paralysis of individual nerves seems to be the most usual complication. Radiculoneuritis or polyneuritis of the Guillain-Barre type is not uncommon. The pain of neuralgic type that is frequently present is probably to be ascribed to peripheral nerve damage (neuritis). Mental complaints in the form of depression and anxiety states not infrequently occur, and are often seen in association with crises of vascular origin. In fact, 50% of the patients exhibit slight mental disturbances during the course of the disease. The findings in the cerebrospinal fluid consist of a raised protein content and moderate pleocytosis. They do not seem to be influenced by the degree of intoxication. The disease has a distinct tendency to recurrence. Mental trauma and physical exertion may be responsible for the often unexplained recurrences, and should therefore be avoided. The best indication of restored health is normalization of the white cell count. If the differential count has become normal, recurrence is rare. The author gives an account of a particularly severe case of mononucleosis, with signs of activity during an 8-month period. In addition to typical changes in the blood and sternal marrow, a positive Paul-Bunnell reaction, thrombocytopenia, generalized lymph-node swelling and liver enlargement, the patient had cardiovascular symptoms, with attacks of paroxysmal tachycardia and hypertonic crises. Signs of encephalomyelitis were also present, with atrophy of hand muscles, fibrillar twitchings of the trunk and limbs, myoclonia of the hands and fingers, as well as neuralgia-like pain around the trunk. The hematologic changes and neurological symptom complex still persisted 8 months after the onset. Improvement took place under treatment with convalescent serum. Neither sufonamide drugs nor antibiotics had any effect on the course.