34/Male, presented with symptoms of nausea, disinhibition, agitation, opsoclonus-myoclonus, ataxia, tremor, facial agnosia developing over a week. On CSF evaluation, he was found to have elevated IgM against WNv, high protein (98mg/dl) and elevated WBCs (134, 37% Lymphs). Workup for malignancy & paraneoplastic process workup was negative. MRI brain showed an area of diffusion restriction in the splenium of corpus callosum. Patient’s MRI findings and opsoclonus-myoclonus and ataxia (OMA) improved significantly with 2 sessions of IVIG.

57/F, presented with fever, headaches, tremor, psychosis, and ataxia, and was subsequently intubated for airway protection. Her CSF analysis showed elevated IgM against WNv, high protein (79mg/dl), and elevated WBC’s (106, 90% Lymphs). MRI brain was unremarkable. One week after onset of symptoms she had facial dyskinesias. Later she developed proximal bilateral lower extremity weakness and had an MRI lumbar spine, which showed myeloradiculitis with contrast enhancement of the conus medullaris and ventral nerve roots. After one session of IVIG, she had partial improvement in weakness.