Jamestown Canyon virus meningoencephalitis mimicking migraine with aura in a resident of Manitoba

Abstract

A 26-year-old man with no substantial medical history presented to an academic emergency department in Winnipeg with a headache and associated neurologic symptoms. The patient reported that earlier in the day while driving a car, he had felt a sudden tingling and numbness in his right foot. This subsequently spread up the right side of his body to his right leg, right arm, and the right side of his face. The episode lasted about 10 minutes before the symptoms spontaneously resolved. Later the same day, a second episode of rightsided numbness occurred. This time, the symptoms were associated with difficulty speaking, prompting the patient to go to the emergency department.Between 45 and 60 minutes after the onset of symptoms, the patient had a moderate-to-severe throbbing headache. The speech and sensory problems resolved within 2 hours and 30 minutes, whereas the headache improved within 11 hours. The patient reported no history of migraine headaches. During the visit to the emergency department, computed tomography (CT) imaging of the brain, CT angiogram of the cervical and cranial arteries and unenhanced magnetic resonance imaging (MRI) of the brain done with diffusion weighted imaging and apparent diffusion coefficient mapping were all unremarkable. The patient returned home the same day with a diagnosis of migraine with aura.Two days later, the patient woke up early in the morning with numbness and tingling in his left foot, which gradually spread over several minutes to his left arm and the left side of his face, and was associated with a headache and a milder degree of speech impairment in the form of word-finding difficulty. No visual symptoms were reported. The patient again presented to the emergency department for further evaluation. Within 1 hour his neurologic deficits had improved, but he continued to complain of a severe bifrontal throbbing headache, with associated nausea, vomiting, photophobia and phonophobia. The headache was worse with standing and activity. The patient reported no fever, chills, sweats, neck stiffness or rash. A review of systems was otherwise negative. The patient lived in Winnipeg and reported no recent travel outside of Manitoba. He had no contact with animals or people who were ill. There was no history of tick exposure. However, the patient did report numerous recent mosquito bites.On physical examination, the patient was afebrile and hemodynamically stable, with a blood pressure of 165/97 mm Hg and a heart rate of 70 beats/min. Cardiac, respiratory and abdominal examinations were unremarkable. No nuchal rigidity or rash was seen. The neurologic examination showed blurring of the optic disk margins bilaterally. Basic electrolytes, serum creatinine and liver enzymes were within normal limits. The patient had a normal total white blood cell count, hemoglobin and platelet count. Additional CT imaging of the brain was unremarkable. Electroencephalography did not show any epileptiform discharges. A repeat MRI of the brain showed suspected leptomeningeal enhancement over both co...

Jamestown Canyon Virus (JCV) Encephalitis Mimicking Acute Stroke in Michigan: A Case Report and Review of the Literature

“…A recent JCV encephalitis case report showed a similar pattern, where the initial MRI was unremarkable, however repeat MRI after few days showed significant bilateral LME. 9 These changes are atypical and, in our patient, this occurred with a rapid resolution of changes in one hemisphere. These changes can be due to the neuro-invasive nature of the virus and disruption of the blood-leptomeningeal barrier.…”

“…8 A recent case from Manitoba, Canada reported recurrent unilateral headaches with speech difficulties, mimicking a migraine with aura. 9 Our patient presented with numbness and tingling of one side, waxing and waning speech difficulty, a viral prodrome of lethargy and night sweats.…”

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Headache Attributed to SARS-CoV-2 Infection or COVID-19 Related Headache—Not Migraine-like Problem-Original Research

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