Disclosures: Bestin Kuriakose, DO: No financial relationships or conflicts of interest

Case Description: Patient complained of a month-long duration of feeling tired, congested and swollen glands around neck and jaw line. Initially treated with oral steroids and antibiotics. Found minimal relief and subsequently started to notice balance issues. Viral etiologies tested and found to be positive for EBV IgM/IgG. MRI brain showed no acute pathology. Patient underwent treatment with IVIG for five days. Lumbar puncture showed increased lymphocytes and increased protein. On admission to acute rehabilitation, patient with full motor strength in all four extremities. Splenomegaly palpated. Neurological examination demonstrated dysmetria, dysdiadochokinesia, Romberg’s sign and nystagmus. Patient had an unsteady, narrow based gait with decreased foot clearance. Dysarthria improved. No sensory deficits appreciated.

Setting: Acute inpatient rehabilitation

Patient: A 38 year old male with history of vertigo, who developed gait instability and dysarthria after upper respiratory symptoms Assessment/

Results: During acute rehabilitation course, therapists focused on functional mobility, with primary emphasis on dynamic/static balance, transfers, and stair negotiation. Dysarthria had resolved and patient did not require speech therapy. Upon discharge home, patient was able to regain a steady gait pattern with the ability to ambulate 150 feet without an assistive device and contact guard/supervision.

Discussion: Neurological deficits in Epstein-Barr virus are an uncommon occurrence. Patients diagnosed with EBV can have a variety of clinical presentations which are not solely neurological. Acute complications can include a morbilliform rash, airway obstruction from lymphoid hyperplasia, and splenic rupture. Cerebellar ataxia can be associated with various diagnoses which may include inflammatory, vascular, paraneoplastic, and autoimmune etiologies which often require further workup.

Conclusion: Cerebellar ataxia is an uncommon neurological finding associated with Epstein Barr virus infection. As demonstrated in this patient, it has a positive functional prognosis with good recovery of gait and balance.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cerebellar-ataxia-in-a-patient-diagnosed-with-epstein-barr-virus-a-case-report/