A case of severe encephalitis due to infectious mononucleosis is reported. An eight year old white boy developed meningeal signs, intermittent coma, opisthotonos, extensor spasms, mild papilledema and hyperpyrexia two weeks after the onset of a sore throat and cervical lymphadenopathy. The diagnosis of infectious mononucleosis was confirmed by a heterophile antibody titer of 1:1024.The neurologic complications of the disease are uncommon in adults and are even more unusual in children. Only seven cases were found in the literature. Any or all parts of the nervous system may become involved; cerebrospinal fluid abnormalities may be the only manifestations of such involvement. The prognosis in children has been uniformly favorable with little or no neurologic residuals.Electroencephalographic and cerebrospinal fluid studies made on patients with infectious mononucleosis indicate a higher incidence of nervous system involvement than is evident by clinical examination.Serial heterophile agglutination determinations in patients with unexplained nervous system manifestations may clarify the diagnosis.
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