NEUROLOGICAL COMPLICATIONS OF GLANDULAR FEVER

Neurological complications of glandular fever are reported to occur in up to 1% of glandular fever illnesses. An account is given of the neurological complications occurring in 234 patients admitted to hospital between 1960 and 1969, inclusive, with a diagnosis of glandular fever, subsequently confirmed hæmatologically and serologically. Two patients suffered from periods of delirium, 24 patients had serous meningitis (meningism) and four suffered from meningo‐encephalitis. All four patients were in coma at the height of the encephalitic illness, and all made a complete recovery. However, one patient died several days later from massive pulmonary embolism. Histological examination of the brain revealed patchy infiltration of the leptomeninges with mononuclear cells, and foci of microglial cells throughout the white and grey matter. These foci were associated with loss of neurons in affected areas in the grey matter. The cerebellum showed considerable swelling of the white matter. No evidence of perivascular demyelination was seen, nor were inclusion bodies found. A brief review of the literature shows that reported neurological complications of glandular fever include serous meningitis, lymphocytic meningitis, meningo‐encephalomyelitis, cranial nerve involvement including optic neuritis, mononeuritis and polyneuritis (Landry‐Guillain‐Barré syndrome). Occasionally transient psychotic episodes such as schizophrenia have been reported. Transverse myelitis has rarely occurred. In most series, recovery from encephalitis has been satisfactory.