A new report and a paper on monkeypox include information about neurological complications affecting the brain and how those were treated. 

There have been more than 24,000 monkeypox cases reported in the U.S., according to the Centers for Disease Control and Prevention. The number of cases seems to have peaked, although we are still learning about how the illness has spread and affected people. 

The CDC reports two acute monkeypox virus (MPXV) cases in Colorado and D.C. this past summer where the patients also had encephalomyelitis, where there is inflammation in the brain and/or spinal cord. For the two patients, neurological symptoms appeared within five and nine days of illness onset. Both patients were given oral tecovirimat, a treatment developed for smallpox. 

The mechanism for how the neurological symptoms appears “is unclear but might represent either MPXV invasion of the [central nervous system]” or an autoimmune process triggered by systemic MPXV infection, states the report. 

In a paper published in the journal JAMA Neurology, doctors review the neurologic complications associated with monkeypox and smallpox cases. They write about the known neurological symptoms from monkeypox, which include headaches and mood disturbances. There’s also the possibility for postvaccinal encephalomyelitis, where there is inflammation in the brain and spinal cord after vaccination. 

Headaches are common with MPXV infections, according to the paper. Other symptoms include mood disturbance, like depression and anxiety, and nerve pain, also known as neuropathic pain. 

For physicians who may be treating MPXV patients, these new reports may help to understand the range of neurological complications their patients may be experiencing. This may include pain management in the form of topical agents, oral medications, or nerve blocks, according to the paper. “Painful lesions may respond to antiviral treatments; hence, access to them is crucial.” 

“Clinicians and public health professionals should be aware of the range of possible clinical presentations of MPXV infections and potential treatments,” write the authors of the CDC report. “Suspected cases should be reported to state, tribal, local, or territorial health departments to improve understanding of the range of clinical manifestations of MPXV infections and treatment options.”