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- Title
Monkeypox‐Associated Central Nervous System Disease: A Case Series and Review.
- Authors
Money, Kelli M.; Barnett, T. Allen; Rapaka, Samuel; Osborn, Rebecca; Kitani, Takashi; Fuguet, Daniel; Amjad, Faria; Clark, Jeffrey R.; Chakravarty, Debanjana; Copeland, Matthew J.; Honce, Justin M.; Kumar, Princy N.; Kumar, Rebecca N.; Mousa‐Ibrahim, Fady; Sirdar, Bilaal; Sobota, Rafal; Tang, Mengxuan; Bolon, Maureen K.; Russell, Eric J.; Wilson, Michael
- Abstract
Objective: Monkeypox virus (MPXV) disease has been declared a public health emergency by the World Health Organization, creating an urgent need for neurologists to be able to recognize, diagnosis, and treat MPXV‐associated neurologic disease. Methods: Three cases of MPXV‐associated central nervous system (CNS) disease occurring during the 2022 outbreak, and their associated imaging findings are presented, with 2 cases previously published in a limited capacity in a public health bulletin. Results: Three previously healthy immunocompetent gay men in their 30s developed a febrile illness followed by progressive neurologic symptoms with presence of a vesiculopustular rash. MPXV nucleic acid was detected by polymerase chain reaction (PCR) from skin lesions of 2 patients, with the third patient having indeterminate testing but an epidemiologic link to a confirmed MPXV disease case. Cerebrospinal fluid demonstrated a lymphocytic pleocytosis, elevated protein, and negative MPXV‐specific PCR. In 2 patients, magnetic resonance imaging of the brain and spine demonstrated partially enhancing, longitudinally extensive central spinal cord lesions with multifocal subcortical, basal ganglia, thalamic, cerebellar, and/or brainstem lesions. The third patient had thalamic and basal ganglia lesions. All patients received 14 days of tecovirimat, and 2 patients also received multiple forms of immunotherapy, including intravenous immunoglobulin, pulsed high‐dose steroids, plasmapheresis, and/or rituximab. Good neurologic recovery was observed in all cases. Interpretation: MPXV can be associated with CNS disease. It is unclear whether this is from a parainfectious immune‐mediated injury or direct CNS viral invasion. ANN NEUROL 2023;93:893–905
- Subjects
WORLD Health Organization; CENTRAL nervous system diseases; CENTRAL nervous system; MAGNETIC resonance imaging; NEUROLOGICAL disorders; BASAL ganglia; NEUROMYELITIS optica
- Publication
Annals of Neurology, 2023, Vol 93, Issue 5, p893
- ISSN
0364-5134
- Publication type
Academic Journal
- DOI
10.1002/ana.26597