Post viral upper and lower motor neuron injuries

A 20-year-old man presented with subacute dysarthria, along with bilateral facial and brachial palsy, after a febrile odynophagia. Initially brisk, his upper limb deep tendon reflexes decreased with muscle wasting concerning the C5-T1 myotomes. MRI showed bilateral prefrontal gyri and thalami lesions with anterior cervical spinal cord lesion (figures 1 and 2). Upper limb lower motor neuron involvement was confirmed by EMG. CSF analysis showed lymphocytic pleiocytosis, elevated protein, and normal glucose levels . Epstein-Barr virus (EBV) serology revealed acute infection with the presence of viral capsid antigen (VCA) immunoglobulin M and VCA immunoglobulin G (IgG), in the absence of Epstein-Barr nuclear antigen–1 IgG. EBV DNA load was increased in blood and CSF. Other investigations including HIV screening remained negative. Simultaneous upper and lower motor neuron injury, well-described in HIV, is an unusual finding in EBV infection.1