Abstract Details

Title Pontine Demyelination Mimicking Central Pontine Myelinolysis in the Setting of Acute Neuroinvasive West Nile Virus Infection

Topic Infections/AIDS/Prion Disease

Presentation(s) P06 - (-)

Poster/Presentation
Number 180

Objective

Background BACKGROUND: A 52 year old male presented to the emergency department of a large community hospital in south Louisiana in August 2012 complaining of diplopia, headache, and gait imbalance, in the setting of an acute febrile upper respiratory illness. Examination revealed bilateral internuclear ophthalmoplegia. MRI brain demonstrated abnormal increased T2 signal within the central pons without corresponding diffusion restriction or enhancement, most consistent with osmotic demyelination. However, lab testing showed a normal sodium of 137. Lumbar puncture was performed, showing lymphocytic pleocytosis (90 WBC, 77% lymphocytes). All CSF viral studies, including West Nile Virus RNA PCR, were negative. However, serum West Nile Virus IgM was positive, with a negative West Nile IgG.

Design/Methods DESIGN/METHODS: Literature search was performed for imaging findings in neuroinvasive West Nile Virus using the PubMed database.

Results RESULTS: Normal MRI is frequently seen in neuroinvasive West Nile Virus. However, MRI brain abnormalities have been reported involving the basal ganglia, thalami, mesial temporal structures, brain stem, and cerebellum. Pontine findings were very uncommon among reported cases of abnormal MRI imaging in the setting of neuroinvasive West Nile virus.

Conclusions CONCLUSIONS: Neuroinvasive West Nile Virus most commonly manifests in meningoencephalitis, flaccid paralysis similar to that seen in polio, or neuromuscular abnormalities. Immune-mediated demyelination within the central nervous system is an extremely rare manifestation of neuroinvasive West Nile Virus. Brain MRI is often normal but may show abnormalities of the gray or white matter on the DWI or T2/FLAIR series. No reports in the current literature described extensive demyelination of the pons. This case presents a unique image of pontine demyelination mimicking central pontine myelinolysis in the setting of acute West Nile Virus infection.

Authors/Disclosures
April A. Erwin, MD (Rocky Mountain Multiple Sclerosis Clinic) PRESENTER	Dr. Erwin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Erwin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Erwin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Celgene. Dr. Erwin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Erwin has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. Dr. Erwin has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Erwin has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novartis. Dr. Erwin has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Erwin has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Bristol-Myers Squibb. The institution of Dr. Erwin has received research support from Genentech. The institution of Dr. Erwin has received research support from Abbvie. The institution of Dr. Erwin has received research support from Novartis. The institution of Dr. Erwin has received research support from Biogen.
Zoltan Mari, MD, FAAN (Cleveland Clinic Lou Ruro Center for Brain Health)	Dr. Mari has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AbbVie. Dr. Mari has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for ACADIA. Dr. Mari has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Mari has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Parkinson Study Group. Dr. Mari has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AbbVie. Dr. Mari has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for ACADIA. Dr. Mari has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for US World Meds. Dr. Mari has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Mari has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Moore and Moore PLLC. Dr. Mari has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Francis Law Firm PLLC. Dr. Mari has stock in NeuroReserve. Dr. Mari has stock in Sensory Cloud. The institution of Dr. Mari has received research support from Cerevel. The institution of Dr. Mari has received research support from AbbVie. The institution of Dr. Mari has received research support from NIH. The institution of Dr. Mari has received research support from Parkinson's Foundation. The institution of Dr. Mari has received research support from Michael J Fox Foundation. The institution of Dr. Mari has received research support from LBDA. The institution of Dr. Mari has received research support from Eli Lilly.

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