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Neurological Manifestations of West Nile Virus Infection

Published online by Cambridge University Press:  16 February 2016

Jodie M. Burton ,
Ralph Z. Kern ,
William Halliday ,
David Mikulis ,
James Brunton ,
Margaret Fearon ,
Caitlin Pepperell  and
Cheryl Jaigobin
Jodie M. Burton
Affiliation:
University Health Network, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada Division of Neurology, University of Toronto, Toronto, Ontario, Canada
Ralph Z. Kern
Affiliation:
University Health Network, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada Division of Neurology, University of Toronto, Toronto, Ontario, Canada
William Halliday
Affiliation:
University Health Network, Toronto, Ontario, Canada Division of Neuropathology, University of Toronto, Toronto, Ontario, Canada
David Mikulis
Affiliation:
University Health Network, Toronto, Ontario, Canada Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada Division of Neuroradiology, University of Toronto, Toronto, Ontario, Canada
James Brunton
Affiliation:
University Health Network, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
Margaret Fearon
Affiliation:
Laboratories Branch, Ministry of Health and Long Term Care, University of Toronto, Toronto, Ontario, Canada
Caitlin Pepperell
Affiliation:
University Health Network, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
Cheryl Jaigobin*
Affiliation:
University Health Network, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada Division of Neurology, University of Toronto, Toronto, Ontario, Canada
*
Toronto General Hospital, University Health Network, Eaton North 11-215, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada.
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Abstract

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Background:

Over the past four years, West Nile virus (WNV) has become a significant health issue in North America. In 2002, WNV infection made its first appearance in the human population in Canada.

Methods:

Patients who presented to the University Health Network and Mount Sinai Hospital in Toronto with neurological disease attributed to WNV infection were identified and followed by the neurology service. Clinical features and results of laboratory, electrodiagnostic, radiological and pathological studies are presented.

Results:

In August and September 2002, 26 patients were admitted with WNV infection; 14 presented with neurological illness. Encephalitis was the most common presentation (11 patients). Eleven patients developed neuromuscular disease; two at presentation and nine after encephalitis. While the majority had a motor process that localized to the anterior horn cell and/or motor neuron, two patients had evidence of a demyelinating neuropathy and one a sensorimotor axonal neuropathy. Less common manifestations included rhombencephalitis, ataxia, myelopathy and parkinsonism. Death occurred in four patients; two > 75 years of age, and two who were immunocompromised.

Conclusions:

The most common neurological manifestation of WNV infection was encephalitis with subsequent neuromuscular involvement. The diversity of clinical and pathological findings, however, suggests widespread involvement of the central and peripheral nervous system. A poorer prognosis for neurological recovery and overall survival was seen in older and immunocompromised patients.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 2 , May 2004 , pp. 185 - 193
Copyright
Copyright © The Canadian Journal of Neurological 2004

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