Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
Neurol Neuroimmunol Neuroinflamm. 2015 Dec 10;3(1):e184. doi: 10.1212/NXI.0000000000000184. eCollection 2016 Feb.
To describe the clinical presentation and unique neurologic manifestations of sandfly viruses (SFVs) in the Jerusalem area.
We identified all patients with acute seroconversion to SFV at the Hadassah-Hebrew University Medical Centers during the years 2008-2013 and retrospectively collected and analyzed the clinical and imaging data.
Nine patients (ranging from 1.5 to 85 years old) were identified. Presentation included acute neurologic disease, mostly with fever, change in consciousness and behavior, seizures, headache, meningitis, limb paresis, or myelitis. Eight patients had clinical signs of meningitis, meningoencephalitis, or encephalitis alone. Four patients had myelitis. MRI identified pathologic symmetrical changes in the basal ganglia, thalami, and other deep structures in 5 patients, and additional myelitis of the spine was noted on imaging in 3 patients. Seven patients had long-term follow-up: 4 completely recovered and 3 had remaining neurologic sequelae, among them 1 with permanent severe brain damage.
Neurologic involvement associated with acute SFV infections is considered to be benign. However, in this series, all 9 patients presented with significant neurologic pathology associated with a unique finding of myelitis and symmetrical basal ganglia, thalami, or white matter involvement. Thus, acute SFV infection should be included in the differential diagnosis in febrile onset of neurologic manifestations and neuroradiologic changes.
描述耶路撒冷地区沙蝇病毒（SFV）的临床特征和独特的神经表现。
我们在 2008 年至 2013 年间确定了所有在哈达萨-希伯来大学医学中心发生急性血清转换的 SFV 患者，并回顾性地收集和分析了临床和影像学数据。
共确定了 9 名患者（年龄 1.5 至 85 岁）。表现包括急性神经系统疾病，主要有发热、意识和行为改变、癫痫发作、头痛、脑膜炎、肢体瘫痪或脊髓炎。8 名患者有单纯脑膜炎、脑膜脑炎或脑炎的临床体征。4 名患者有脊髓炎。5 名患者的 MRI 显示基底节、丘脑和其他深部结构有病理对称性改变，3 名患者的脊髓有额外的脊髓炎。7 名患者有长期随访：4 名完全恢复，3 名有遗留的神经系统后遗症，其中 1 名有永久性严重脑损伤。
与急性 SFV 感染相关的神经系统受累被认为是良性的。然而，在本系列中，所有 9 名患者均表现出明显的神经系统病变，伴有独特的脊髓炎和基底节、丘脑或白质对称性受累。因此，急性 SFV 感染应包括在发热性起病的神经系统表现和神经影像学改变的鉴别诊断中。
