| Bilateral Abducens Nerve Palsy in Pediatric Patients with Epstein-Barr Virus Encephalitis. |
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Min Seok Kim, Jin Choi, Jae Ho Jung |
1Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea. jinchoi@paik.ac.kr
2Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea. |
| 소아 환자에서 엡스타인-바 바이러스 뇌염에 동반된 양안 외향신경마비 |
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김민석1⋅최 진1⋅정재호2 |
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Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine1, Seoul, Korea Department of Ophthalmology, Pusan National University School of Medicine2, Busan, Korea |
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| Abstract |
PURPOSE
To report 2 cases that presented with bilateral abducens nerve palsy associated with Epstein-Barr virus (EBV) encephalitis in children. CASE SUMMARY: Case 1. A 14-month-old boy presented with fever and esodeviation of the left eye that started 5 days earlier. On the ophthalmic examination, 45-PD esotropia of the left eye and limitation of abduction in both eyes were observed. On neurological examination, there were no abnormalities. Serologic test and polymerase chain reaction (PCR) from cerebrospinal fluid (CSF) were positive for EBV. The patient was treated with systemic acyclovir and prednisolone. Part-time occlusion therapy of the right eye for 2 hours/day was also prescribed. The patient underwent a 6.5-millimeter recession of the medial rectus and a 6-millimeter resection of the lateral rectus on the left eye 7 months after the presentation. The patient showed orthotropia 1 week after the surgery without neurologic sequelae. Case 2. A 13-year-old boy presented with headaches and fever that started 5 days before and altered consciousness with seizures 2 days previously. Serological test for viral infection was normal, except for EBV, and CSF examination showed viral infection. After the patient recovered consciousness, he complained of diplopia. A 30-PD esotropia of his left eye with bilateral limitation of abduction was present. Alternating full-time occlusion of both eyes was prescribed. At 4 months after presentation, diplopia disappeared and the patient showed orthotropia without abduction limitation; however, anticonvulsants were prescribed to control seizures. CONCLUSIONS: In children, EBV encephalitis can be accompanied by acquired bilateral abducens nerve palsy. Residual nerve palsy and other neurologic sequelae can remain after several months. |
| Key Words:
Acquired abducens nerve palsy;Encephalitis;Epstein-Barr virus;Neurologic sequelae |
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