Primary Epstein-Barr-virus infections in acute neurologic diseases

Infectious mononucleosis has been associated with Guillain--Barré syndrome, Bell's palsy, meningoencephalitis and transverse myelitis. Since it is not known that many children with infectious mononucleosis do not develop heterophil antibodies, we looked for evidence of current or recent Epstein-Barr virus infection in young patients with these neurologic diseases by using serodiagnostic procedures for detection and titration of antibodies to various antigens related to Epstein-Barr virus. Seven of 24 cases with Guillain-Barre syndrome and three of 16 with facial palsy were definitely associated with primary infection with Epstein-Barr virus as were two cases each of the other two neurologic diseases. Only one of these patients had obvious clinical infectious mononucleosis, and only a few demonstrated heterophil agglutinins. It is evident that the virus must be considered in the diagnosis of various acute neurologic diseases affecting children and young adults, even in the absence of heterophil-antibody response or other signs of infectious mononucleosis.

Generalized mastocytosis, relapsing herpes zoster and polyradiculoneuritis

A 68-year-old woman suffering from a longstanding urticaria pigmentosa with mast cell infiltrations in bones had two attacks of herpes zoster. The second herpes zoster attack was followed by a severe polyradiculoneuritis (Guillain-Barré syndrome). The sequence of events suggests an immunological deficiency.

Serum IgE concentrations in neurological diseases

Serum IgE levels were determined in 42 patients with Guillain Barre Syndrome and 22 patients with multiple sclerosis. Serum IgE concentrations were significantly elevated in about half of the patients with acute Guillain Barre Syndrome and tends to fall in patients with clinical improvement. Patients with multiple sclerosis and other acute and chronic central nervous system and peripheral system diseases have normal serum IgE levels. IgE is an important mediator of tissue damage in allergic diseases of immediate type and may also play an important role in acute Guillain Barre Syndrome.

Cellular hypersensitivity in Guillain-Barré syndrome

The Guillain-Barré syndrome is hypothesized to be secondary to cellular hypersensitivity to peripheral nerve antigens. To test this theory lymphocytes from 100 subjects were studied using the macrophage-migration-inhibition factor (MIF) assay. Thirty-four normal controls gave a mean migration of 100.4 +/- 9%. Of 34 patients with peripheral nervous system disease, only those with the Guillain-Barré syndrome showed hypersensitivity with a mean migration of 72 +/- 11%. Of 34 patients with central nervous system disease only three with multiple sclerosis and two with stroke gave similar results. Positive results in the Guillain-Barré syndrome were found only in patients presenting with classical disease and who were ill at the time of study.

Idiopathic acute symmetrical polyradiculoneuritis. The Landry-Guillain-Barré-Strohl syndrome

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