Hepatitis E Virus Infection: Neurological Manifestations and Pathophysiology

Hepatitis E virus (HEV) is the first cause of viral hepatitis in the world. While the water-borne HEV genotypes 1 and 2 are found in developing countries, HEV genotypes 3 and 4 are endemic in developed countries due to the existence of animal reservoirs, especially swine. An HEV infection produces many extra-hepatic manifestations in addition to liver symptoms, especially neurological disorders. The most common are neuralgic amyotrophy or Parsonage-Turner syndrome, Guillain-Barre syndrome, myelitis, and encephalitis. The pathophysiology of the neurological injuries due to HEV remains uncertain. The immune response to the virus probably plays a role, but direct virus neurotropism could also contribute to the pathophysiology. This review describes the main neurological manifestations and their possible pathogenic mechanisms.

Automated summary

HEV is the primary cause of viral hepatitis worldwide, with different genotypes prevalent in different countries. In addition to liver symptoms, an HEV infection can also lead to neurological disorders, with the pathophysiology not yet fully understood.