The Epstein-Barr virus can cause neurological symptoms in some people. These symptoms may arise due to an infection of the nervous system or post-infection inflammation.
Epstein-Barr virus (EBV) infection is one of the most common viral infections in humans. Most people exposed to the virus don’t develop symptoms or only have mild symptoms. It’s the most common cause of mononucleosis, which often causes swollen lymph nodes in the neck and fatigue.
Neurological symptoms caused by EBV can range from mild to life threatening. Severe complications are rare but are more common in people with suppressed immune systems.
An EBV infection can cause a range of neurological symptoms due to either inflammation of the nervous system or a direct infection of it.
Encephalitis
Encephalitis is inflammation of your brain and is a rare complication of EBV infection. In a 2023 review, researchers found 97 documented cases in the medical literature.
Encephalitis can cause symptoms such as:
- loss of consciousness
- confusion
- disorientation
- seizures
- changes in personality or behavior
- weakness or movement problems
Meningitis
Meningitis is inflammation of the layers that cover your brain and spinal cord. Most cases of EBV-induced meningitis are mild and short-lived. Typical meningitis symptoms can include:
- fever
- headache
- stiff neck
- nausea and vomiting
- light sensitivity
- confusion
Optic neuritis
Optic neuritis is swelling in your optic nerve. It can cause symptoms such as:
- loss of vision in one eye that progresses over hours
- loss of color vision
- pain when you move your eye
Optic neuritis related to EBV infection is rare, with only a few cases reported in the medical literature. Most cases occurred after infectious mononucleosis.
However, a 2018 case study notes a case that occurred after a solid organ transplant. Immunosuppressant drugs are typically given after a transplant, which can reactivate the virus.
Alice in Wonderland syndrome
Alice in Wonderland syndrome is a neurological symptom that disrupts how you perceive your body or the world around you. You may:
- have trouble judging the size of objects or your own body
- lose your sense of time
- become depersonalized
- become detached from reality
Although rare, isolated reports of Alice in Wonderland syndrome developing in people with an EBV infection have been reported. For example, researchers reported a
Guillain-Barré syndrome
Guillain-Barré syndrome is a rare neurological condition that usually affects nerves in your arms and legs before causing symptoms in other areas of your body.
These symptoms may include trouble breathing or swallowing. You may have symptoms that get worse over 2 to 4 weeks, such as:
- pins and needles sensation
- tingling
- numbness
- muscle weakness
You may also develop other symptoms such as:
- sharp pain in your legs or back
- breathing problems
- drooping face muscles or trouble swallowing
- vision changes
- diarrhea
- constipation
Guillain-Barré syndrome usually starts within a few weeks of an infection.
Other disorders
Other neurological complications that can develop in people with EBV infection include:
- sleep problems
- headaches
- acute cerebellar ataxia, sudden uncontrolled muscle movement
- facial nerve palsy
- transverse myelitis, swelling of the spinal cord
Common signs and symptoms of EBV infection can include:
- fatigue
- fever
- sore throat
- swollen lymph nodes in your neck
- rash
- enlarged liver
- rash
Most people recover from the infection after
What does a flare-up of EBV infection feel like?
The Epstein-Barr virus dormant remains in your body after infection. You may have a reactivation of the infection in the future, especially during periods of:
- stress
- when taking certain medications
- periods of immunosuppression
Reactivation of the Epstein-Barr virus can cause neurological symptoms. Sometimes, symptoms may resemble those present during the first infection, but not always.
Most of the common symptoms of EBV infection can be managed with:
- rest
- staying hydrated
- medications to help with fever and pain
Many neurological complications of Epstein-Barr infection require hospitalization, although these complications are rare.
Medications
Encephalitis may be treated with medications such as:
- the antiviral acyclovir
- the antiviral ganciclovir
- corticosteroids
- immunoglobulin
Meningitis often doesn’t require specific treatment. Instead, you may be given supportive care, such as intravenous fluids or medication to reduce inflammation.
Guillain-Barré syndrome may be treated with:
- immunotherapy to help prevent damage to your nervous system
- ventilation to support breathing
- plasma exchange to remove harmful antibodies
Steroids may be prescribed for optic neuritis to reduce inflammation. Left untreated, optic neuritis can lead to vision loss.
There’s no specific treatment for AWS. It’s typically managed with the same strategies used for migraine.
Most people with an EBV infection have mild or no perceptible symptoms. Some people may develop neurological symptoms that can range from mild to life threatening.
It’s important to see a healthcare professional any time you develop unexplained neurological symptoms such as numbness, tingling, or trouble with movement.
These symptoms have many potential causes, so a medical diagnosis is needed to find the root cause.