Meningoencephaloradiculomyelitis after tick-borne encephalitis virus infection: a case series.

ABSTRACT

BACKGROUND: Tick-borne encephalitis (TBE) is caused by a RNA-virus and is in about 50% of cases characterized by a biphasic clinical course in adults. Different clinical syndromes have been described, including meningitis, meningoencephalitis, meningoencephalomyelitis and meningoencephaloradiculomyelitis. The latter seems to be the most disabling and severe form of TBE virus infection. METHODS: Here we report five cases with meningoencephaloradiculomyelitis. Only in three patients a tick prick was remembered. RESULTS: Only two patients could be weaned successfully from assisted ventilation; only one patient was able to return to self-dependent life without nursing support. The youngest patient in this case series showed the most favourable outcome. CONCLUSIONS: Polyradiculopathy and/or myelopathy as verified by electrophysiological examination within 4 weeks from symptom onset were indicative of a more severe disease course and a greater likelihood of moderate to serious sequelae even after long-term rehabilitation. Older age at symptom onset seems to be associated with a less favourable outcome. Because of frequent long-term hospitalization with immobilization and invasive ventilation, secondary complications, such as ventilation associated pulmonary infections and decubiti, must be avoided.