Critical West Nile Neuroinvasive Disease

Hawkes, Maximiliano A.; Carabenciov, Ivan D.; Wijdicks, Eelco F. M.; Rabinstein, Alejandro A.

doi:10.1007/s12028-017-0500-x

Cited by 18 publications

(16 citation statements)

References 9 publications

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“…PubMed database search, using combination of terms “West Nile virus”, “WNV”, “encephalitis”, “myelitis”, “cauda equina”, and “magnetic resonance“ (MR), has identified seven publications in total (five case series and two individual cases). Four case series originated from the United States (three in 2002, one comprising patients from 1996 to 2016), and one from Serbia (in 2012)[ 6 , 8 , 16 - 18 ]. The total number of patients included was 147, the total number of patients with brain MR performed was 75, while the total number of patients with spinal MR was 33.…”

Section: Discussionmentioning

confidence: 99%

“…WNV NID usually presents as meningitis, encephalitis, acute flaccid paralysis, or as a combination of the conditions above[ 5 ]. Although rare, WNV NID can be life-threatening, may require long-term hospitalization and rehabilitation, and leave long-lasting neurological sequelae[ 6 ]. The epidemiology, clinical presentation, and virology diagnostic methods of WNV infection are well established[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Cauda equina arachnoiditis – a rare manifestation of West Nile virus neuroinvasive disease: A case report

Santini

Župetić

Višković

et al. 2020

WJCC

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BACKGROUND Data regarding the neuroradiology features of the West Nile virus neuroinvasive disease (WNV NID) is rather scarce. To contribute to the knowledge of the WNV NID, we present a patient with a combination of encephalitis and acute flaccid paresis, with cauda equina arachnoiditis as the main magnetic resonance (MR) finding. CASE SUMMARY A 72-year-old female patient was admitted due to fever, headache and gait instability. During the first several days she developed somnolence, aphasia, urinary incontinence, constipation, and asymmetric lower extremities weakness. Cerebrospinal fluid analysis indicated encephalitis. Native brain computed tomography and MR were unremarkable, while spinal MR demonstrated cauda equina enhancement without cord lesions. Virology testing revealed WNV IgM and IgG antibodies in serum and cerebrospinal fluid, which confirmed acute WNV NID. The treatment was supportive. After two months only a slight improvement was noticed but cognitive impairment, loss of sphincter control and asymmetric inferior extremities weakness remained. The patient died after a month on chronic rehabilitation. CONCLUSION Cauda equina arachnoiditis is a rare, but possible neuroradiological feature in acute flaccid paresis form of WNV NID.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cauda equina arachnoiditis – a rare manifestation of West Nile virus neuroinvasive disease: A case report

Santini

Župetić

Višković

et al. 2020

WJCC

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“…West Nile-associated neurologic diseases can also manifest as a poliomyelitis-like syndrome and acute flaccid paralysis characterized mainly by muscle weakness that, in most cases, evolves to respiratory failure 73,74 . Although neurological diseases associated with WNV infections can arise at any age, the elderly and immunocompromised patients, like those with cancer, diabetes, hypertension, kidney disease, and transplant recipients, are at greater risk 75,76 . The case fatality rate is higher in elderly people, especially those over 65 years of age.…”

Section: Clinical Manifestations In Humansmentioning

confidence: 99%

West Nile virus infections are here! Are we prepared to face another flavivirus epidemic?

Castro-Jorge

Siconelli

Ribeiro

et al. 2019

Rev. Soc. Bras. Med. Trop.

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Emerging arthropod-borne viruses (arboviruses), such as chikungunya and Zika viruses, are a major threat to public health in countries like Brazil where biodiversity is high and medical care is sometimes precarious. West Nile fever is a disease caused by the West Nile Virus (WNV), an RNA virus belonging to the Flaviviridae family. It is transmitted by infected mosquitoes to numerous animals like birds, reptiles and mammals, including human and non-human primates. In the last decade, the number of reported cases of WNV infection in humans and animals has increased in the Americas. Circulation of WNV in forests and rural areas in Brazil has been detected based on serological surveys and, in 2014, the first case of West Nile fever was confirmed in a patient from Piauí State. In 2018, the virus was isolated for the first time from a horse from a rural area in the state of Espírito Santo presenting with a neurological disorder; this raises the possibility that other cases of WNV encephalitis may have occurred without clinical recognition and without laboratory diagnosis by specific assays. The imminent WNV outbreak poses a challenge for Brazilian clinicians and researchers. In this review, we summarize the basic biological and ecological characteristics of this virus and the clinical presentation and treatment of febrile illnesses caused by WNV. We also discuss the epidemiological aspects, prophylaxis of WNV infections, and monitoring strategies that could be applied in the possibility of a WNV outbreak in Brazil.

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“…Patients younger than 30 years of age who remain largely alert have a much higher chance of returning to preinfection normal life than older patients with altered consciousness. Encephalitis leading to coma is associated with poor outcome, largely because the available treatments are ineffective 40 41. A small proportion will awaken, and an even smaller proportion will regain independent status.…”

Section: Prognosis By Disease Categoriesmentioning

confidence: 99%

“…A patient who is comatose from West Nile virus encephalitis has a high risk of mortality. Patients requiring mechanical ventilation may seem to have a poor prognosis, but many can show substantial recovery over a number of years 40 41. These recoveries cannot be adequately predicted.…”

Section: Prognosis By Disease Categoriesmentioning

confidence: 99%

Predicting the outcome of a comatose patient at the bedside

Wijdicks

2019

Pract Neurol

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The call to the bedside and the prognostication of a comatose patient—telling family members what to expect—commonly falls to neurologists. The assessment is often confounded by the treatment paradigms of modern intensive care (ie, drugs, drug interactions and targeted temperature management). Patients may be too unstable to leave the intensive care unit for neuroimaging; thus, repeated clinical examinations are decisive. Despite diverse causes, certain principles do apply: (1) Many patients can improve, although with significant abnormalities; (2) Neuroimaging and electrodiagnostic tests can help but are rarely definitive; (3) Secondary involvement of the upper brainstem marks a tipping point with much lower probability for an independent outcome; (4) We rarely predict mortality or diagnose brain death; usually the major concern is anticipated neurological deficits; and (5) Prior comorbidity and permanent organ dysfunction are critical factors in making decisions about de-escalation or escalation of care. This review provides a practical approach to evaluating outcome of a comatose patient. Prognostication is difficult, and we should only attempt it when the diagnosis is confirmed and appropriate (often aggressive) medical or surgical treatment has been tried.

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Critical West Nile Neuroinvasive Disease

Abstract: WNND requiring ICU care has a high morbidity and mortality, especially among older patients. Survivors are highly disabled at discharge, but many improve over time. Therefore, more data on the long-term prognosis of survivors are needed to guide the goals of care in the acute setting.

Cited by 18 publications

References 9 publications

Cauda equina arachnoiditis – a rare manifestation of West Nile virus neuroinvasive disease: A case report

Cauda equina arachnoiditis – a rare manifestation of West Nile virus neuroinvasive disease: A case report

West Nile virus infections are here! Are we prepared to face another flavivirus epidemic?

Predicting the outcome of a comatose patient at the bedside

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