Abstract Details

Title West Nile Virus Encephalitis with Acute Parkinsonism Features: A Case Report and Review of Literature

Topic Neurotoxicology

Presentation(s) P01 - (-)

Poster/Presentation
Number 050

Objective

Background As of October 9, 2012, a total of 4,249 cases of West Nile virus disease, including 168 deaths, have been reported to CDC. Only a small proportion (<1%) will develop acute neurological illness and Parkinsonism is a rare manifestation.

Design/Methods Pub med search was performed to identify published papers in English language with WNV infection with Parkinsonism features.

Results Patient a 35 year old man with no prior history of movement disorder was hospitalized with generalized weakness, left hand tremor and gait difficulty. Neurological examination revealed diminished facial expression, hypophonia, mild cog wheel rigidity and left hand tremor. His gait was shuffling with reduced arm swing. MRI of the brain showed hyper intensity in FLAIR, PD and T2 sequences involving the substantia nigra, putamen on the right side and centrum semiovale. CSF analysis showed 22 WBC/mm3 (98% lymphocytes), glucose level of 61 mg/dl and a protein level of 70mg/dl. CSF culture was negative for bacteria. CSF WNV IGG and IGM were positive (4.54 and 45.59 respectively). Patient was started on Carbidopa-levadopa 25-100 mg TID for his Parkinsonism features, following which at the time of discharge there was improvement in facial expression, speech as well as gait. On literature review we could identify 7 papers with 19 patients. In one study at 8 months follow up, Parkinsonism persisted in 5/11. In another study in both the cases it was transient.

Conclusions Parkinsonism features are a rare manifestation of WNV infection. The short term outcome is variable and long term outcome studies are lacking. Though in one study the persistence of MRI findings was associated with severe persistent Parkinsonism, larger studies with longer follow up are needed to validate the observation.

Authors/Disclosures
Vijayakumar Javalkar, MD, MCh, FAAN (LSUHSC Shreveport) PRESENTER	Dr. Javalkar has nothing to disclose.
Charles P. Thomas, MD (Neurology Care, P.L.L.C)	No disclosure on file
Robert N. Schwendimann, MD, FAAN	No disclosure on file
Carmen Castrillo-Viguera	Dr. Castrillo-Viguera has received personal compensation for serving as an employee of Biogen. Dr. Castrillo-Viguera has received stock or an ownership interest from Biogen.

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