BACKGROUND & AIMS Hepatitis E virus (HEV) has been associated with a number of neurological syndromes, but causality has not yet been established. The aim of this study was to explore the relationship between HEV and neurological illness by prospective HEV testing of patients presenting with acute non-traumatic neurological injury. METHODS Four hundred and sixty-four consecutive patients presenting to hospital with acute non-traumatic neurological illnesses were tested for HEV by serology and PCR from four centres in the UK, France and the Netherlands. RESULTS Eleven of 464 patients (2.4%) had evidence of current/recent HEV infection. Seven had HEV RNA identified in serum and four were diagnosed serologically. Neurological cases in which HEV infection was found included neuralgic amyotrophy (n=3, all PCR positive); cerebral ischemia or infarction (n=4); seizure (n=2); encephalitis (n=1); and an acute combined facial and vestibular neuropathy (n=1). None of these cases were clinically jaundiced and median ALT at presentation was 24IU/L (range 8-145). Cases of HEV-associated neuralgic amyotrophy were found in each of the participating countries: all were middle-aged males with bilateral involvement of the brachial plexus. CONCLUSIONS In this cohort of patients with non-traumatic neurological injury, 2.4% had evidence of HEV infection. Symptoms of hepatitis were mild or absent and no patients were jaundiced. The cases of HEV-associated neuralgic amyotrophy had similarities with other HEV-associated cases described in a large retrospective study. This observation supports a causal relationship between HEV and neuralgic amyotrophy. To further understand the relevance of HEV infection in patients with acute neurological illnesses, case-control studies are warranted. Lay summary: Hepatitis E virus (HEV), as its name suggests, is a hepatotropic virus, i.e. it causes damage to the liver (hepatitis). Our findings show that HEV can also be associated with a range of injury to the nervous system.

中文翻译：

---

戊型肝炎病毒感染和急性非创伤性神经损伤：一项前瞻性多中心研究

背景和目的 戊型肝炎病毒 (HEV) 与许多神经系统综合征有关，但因果关系尚未确定。本研究的目的是通过对出现急性非创伤性神经损伤的患者进行前瞻性 HEV 检测，探讨 HEV 与神经系统疾病之间的关系。方法 连续 464 名因急性非创伤性神经系统疾病入院的患者通过血清学和 PCR 检测来自英国、法国和荷兰的四个中心的 HEV。结果 464 名患者中有 11 名 (2.4%) 有当前/最近感染 HEV 的证据。七人在血清中鉴定出 HEV RNA，四人通过血清学诊断。发现 HEV 感染的神经系统病例包括神经痛性肌萎缩（n=3，所有 PCR 阳性）；脑缺血或梗塞（n=4）；癫痫发作（n=2）；脑炎（n=1）；和急性联合面部和前庭神经病变（n=1）。这些病例均未出现临床黄疸，就诊时的中位 ALT 为 24IU/L（范围 8-145）。在每个参与国都发现了 HEV 相关的神经痛性肌萎缩病例：均为双侧臂丛神经受累的中年男性。结论 在这组非创伤性神经损伤患者中，2.4% 有 HEV 感染的证据。肝炎症状轻微或无症状，没有患者出现黄疸。HEV 相关神经痛性肌萎缩病例与大型回顾性研究中描述的其他 HEV 相关病例有相似之处。这一观察结果支持 HEV 和神经痛性肌萎缩之间的因果关系。为了进一步了解 HEV 感染与急性神经系统疾病患者的相关性，有必要进行病例对照研究。小结：戊型肝炎病毒（HEV），顾名思义，是一种嗜肝病毒，即它会对肝脏造成损害（肝炎）。我们的研究结果表明，HEV 也可能与一系列神经系统损伤有关。