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Mononeuritis des N. oculomotorius bei infektiöser Mononukleose

Isolated neuritis of the oculomotor nerve in infectious mononucleosis

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Zusammenfassung

Ein 19-jähriger immunkompetenter Patient entwickelte rechtsseitige Kopfschmerzen und in der Folge subakut Doppelbilder. Klinisch bestand eine inkomplette Okulomotoriusparese rechts. Die zerebrale MRT zeigte eine pathologische Kontrastmittelaufnahme des rechten N. oculomotorius an seiner Austrittsstelle aus dem Mesenzephalon und der Liquor eine leichte Pleozytose. Für relevante differenzialdiagnostische Ursachen, insbesondere Neurosarkoidose, Neuroborreliose, Neurolues, tuberkulöse Meningitis, virale Meningitis (HIV, VZV, CMV), ZNS-Lymphom, Vaskulitis bei rheumatologischer Grunderkrankung, Tolosa-Hunt-Syndrom und diabetische Neuropathie fand sich kein Anhalt. Hingegen wurde eine infektiöse Mononukleose mit Lymphozytose, heterophilen Antikörpern (Paul-Bunnell-Test), IgM-Antikörpern gegen Epstein-Barr-Virus-Capsid-Antigen und erhöhten Transaminasen diagnostiziert. Die Mononeuritis des N. oculomotorius ist eine seltene parainfektiöse Manifestation der Mononukleose.

Summary

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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Literatur

  1. Berlit P (2006) Klinische Neurologie, 2 edn. Springer Medizin Verlag

  2. Nellhaus G (1966) Isolated oculomotor nerve palsy in infectious mononucleosis. A report of an unusual case and review of the literature. Neurology 16: 221–224

    PubMed  CAS  Google Scholar 

  3. Watters MR (1984) Oculomotor palsy in infectious mononucleosis: case report. Mil Med 149: 33–34

    PubMed  CAS  Google Scholar 

  4. Ishibashi A, Sueyoshi K, You M, Yokokura Y (1998) MR findings in isolated oculomotor nerve palsy associated with infectious mononucleosis caused by Epstein-Barr virus infection. J Comput Assist Tomogr 22: 995–997

    Article  PubMed  CAS  Google Scholar 

  5. Portegies P, Corssmit N (2000) Epstein-Barr virus and the nervous system. Curr Opin Neurol 13: 301–304

    Article  PubMed  CAS  Google Scholar 

  6. Connelly KP, DeWitt LD (1994) Neurologic complications of infectious mononucleosis. Pediatr Neurol 10: 181–184

    Article  PubMed  CAS  Google Scholar 

  7. Küppers R (2003) B cells under influence: transformation of B cells by Epstein-Barr virus. Nat Rev Immunol 3: 801–812

    Article  PubMed  Google Scholar 

  8. Bhatti MT, Schmalfuss IM, Eskin TA (2005) 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 50: 598–606

    Article  PubMed  Google Scholar 

  9. Oksanen V, Gronhagen-Riska C, Tikanoja S et al. (1986) Cerebrospinal fluid lysozyme and beta 2-microglobulin in neurosarcoidosis. J Neurol Sci 73: 79–87

    Article  PubMed  CAS  Google Scholar 

  10. Schweisfurth H, Wernze H (1979) Changes of serum angiotensin I converting enzyme in patients with viral hepatitis and liver cirrhosis. Acta Hepatogastroenterol (Stuttg) 26: 207–210

    Google Scholar 

  11. Garcia-Rivera CA, Rozen TD, Zhou D et al. (2001) Miller Fisher syndrome: MRI findings. Neurology 57: 1755

    PubMed  CAS  Google Scholar 

  12. Candy B, Hotopf M (2006) Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev 3:CD004402

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik für Neurologie, Johann-Wolfgang-Goethe-Universität, Schleusenweg 2–16, 60528, Franfurt am Main, Deutschland

    Y. Erben, C: Gonzalez Hofmann, H. Steinmetz &  U. Ziemann

  2. Klinik für Psychiatrie und Psychotherapie, Universitätsklinik, Frankfurt am Main, Deutschland

    C: Gonzalez Hofmann

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  1. Y. Erben
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  2. C: Gonzalez Hofmann
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  3. H. Steinmetz
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  4. U. Ziemann
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Correspondence to U. Ziemann.

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Erben, Y., Gonzalez Hofmann, C., Steinmetz, H. et al. Mononeuritis des N. oculomotorius bei infektiöser Mononukleose. Nervenarzt 79, 462–464 (2008). https://doi.org/10.1007/s00115-007-2385-y

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  • DOI: https://doi.org/10.1007/s00115-007-2385-y

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