Central nervous system-related symptoms and findings are common in acute Puumala hantavirus infection

Figures & data

Table I. Clinical characteristics of all 58 patients and those with normal (17 patients) or abnormal (25 patients) CSF findings or any MRI pituitary finding (MRI+, 6 patients). Hemoglobin concentration (Hb, g/L), thrombocyte count (×10⁹/L), white blood cell (WBC) count (×10⁹/L), and blood pressure (BP) at the time of hospital entry are shown. The highest values of plasma creatinine (mmol/L) and C-reactive protein (CRP, mg/L) during the hospitalization are given. None of the patients required dialysis.

	Normal CSF	Abnormal CSF	Pituitary MRI+	All
Age	48.4	48.6	42.5	47.4
Female (%)	47.1	20.0	16.6	25.8
Hb	145	157	162	152
Thrombocytes	79	62	63	69
WBC	7.6	11.1	10.2	10.0
CRP	95	81	115	88
Creatinine	137^a	346^a	230	308
Systolic BP	131	128	131	128
Diastolic BP	79	83	81	79
Length of hospitalization	5.4	5.1	5.5	5.5
Dialysis	0	0	0	0

^aStatistically significant association between the abnormal CSF finding and the peak creatinine concentration is seen (P < 0.01).

Figure 1. T1-weighted sagittal (A) and coronal (B) magnetic resonance images in a 34-year-old male patient displayed increased signal intensity in the pituitary gland consistent with hemorrhage. The patient developed hypopituitarism in the acute phase of the illness. Three months later (C and D) the pituitary gland had decreased in size, the signal intensity had normalized, as had his hormonal values.