Barr humbug: acute cerebellar ataxia due to Epstein-Barr virus

Abstract

Epstein-Barr virus (EBV) infection is associated with neurological sequellae, but rarely there is acute cerebellar ataxia (ACA) in an adult. We present a novel case of a 26-year-old man, who presented with ACA. He had normal MRI and CSF analysis. Serum testing confirmed active EBV. A course of oral prednisolone 1 mg/kg for 4 weeks, with a subsequent taper was started. He made a full recovery within 3 weeks of presentation.

Figure 1

Blood film (×400 magnification). The blood film showing multiple ‘atypical’ lymphocytes, which are pleomorphic, have large amounts of cytoplasm and prominent nucleoli. Indentations of the cytoplasm created by the surrounding red blood cells can be seen (arrows). The changes are a reaction to viral antigenic stimulation. In the presence of Epstein-Barr virus, these cells are sometimes referred to as Downey cells with reference to Hal Downey who contributed to their first characterisation.