Abstract Details

Title Chorea after West Nile Virus Encephalitis: A Case Report

Topic Movement Disorders

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-053

Objective

To discuss an unusual case of chorea in West Nile Virus encephalitis.

Background The neuroinvasive form of human infection with West Nile Virus (WNV) is known to cause meningitis, encephalitis, and poliomyelitis, particularly in the elderly and immunocompromised. WNV has a particular tropism for extrapyramidal structures and tremor, myoclonus, and parkinsonism have been most commonly described in cases of WNV encephalitis.

Design/Methods Case report and review of literature.

Results Case Presentation: A 75-year-old woman with mild cognitive impairment presented to an outside hospital with encephalopathy for two weeks. Upon transfer to our institution, the patient was obtunded with subtle oromandibular dyskinesias. CSF was inflammatory: 39 WBC, 83% lymphocytes; 190 RBC with positive WNV IgM. CSF studies were otherwise negative: culture, HSV 1/2, enterovirus, AFB stain, listeria, varicella, VDRL, Eastern and Western Equine viruses, SLE antibodies, paraneoplastic panel, and cytology. MRI of the brain with contrast showed chronic T2/FLAIR hyperintensities consistent with microvascular disease and no areas of enhancement. Forty-eight hours of EEG showed no epileptiform activity. There was no evidence of other infection or significant metabolic derangement. She was treated conservatively and her alertness improved, but she was disinhibited and emotionally labile which was not her baseline. One month after the onset of symptoms, her providers noticed the gradual progression of continuous flowing movements of her arms and trunk. Her examination was notable for clear truncal and appendicular chorea which gradually improved without treatment. She was discharged to a nursing facility due to persistent neuropsychiatric symptoms.

Conclusions WNV infection causes a broad spectrum of movement disorders, but chorea has not been reported in the literature in the setting of encephalitis. It should be considered on the differential diagnosis of acute-onset chorea. The course in this case suggests a self-limited condition in the recovery phase from WNV infection in the absence of MRI abnormalities.

Authors/Disclosures
Alana E. Kirby, MD, PhD (Rush University Medical Center) PRESENTER	The institution of Dr. Kirby has received research support from National Institutes of Health. The institution of Dr. Kirby has received research support from Cohn Family. The institution of Dr. Kirby has received research support from Postma Family.
Mitra Afshari, MD (Rush University Movement Disrders)	Dr. Afshari has received research support from Consolidated Anti-Aging Foundation . Dr. Afshari has received research support from Parkinson Study Group.

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