Supranuclear Ophthalmoplegia in Powassan Encephalitis

Powassan virus infection: case series and literature review from a single institution

“…The spectrum of infection varies from nonspecific prodrome of upper respiratory symptoms leading to varied neurological involvement such as headache, dizziness, weakness, and hemiplegia [8]. Gholam et al and a few other researchers have reported a high case fatality rate of up to 5 to 10% with high rates of residual neurological dysfunction in the survivors including hemiplegia, memory impairment, and ophthalmoplegia [5,8-10]. …”

Powassan virus, a scoping review of the global evidence

“…Potential risk factors for humans infected with POWV were reported in 22 studies and included exposure to tick bites (11/22) (Cavanaugh et al., ; El Khoury, Camargo, White, et al., ; Granger, Lopansri, Butcher, Wong, & Tavakoli, ; Johnson, Staples, Sotir, Warshauer, & Davis, ; Piantadosi et al., , ; Raval, Singhal, Guerrero, & Alonto, ; Rossier, Harrison, & Lemieux, ; Smith et al., ; Trépanier, Loungnarath, Gourdeau, Claessens, & Savard, ; Tutolo, Staples, Sosa, & Bennett, ); residing, vacationing, or frequenting wooded areas (12/22) (Ananthan, Shah, Haseer‐Koya, & Patel, ; Choi & Taylor, ; Courtney et al., ; El Khoury, Camargo, White, et al., ; Fitch & Artsob, ; Goldfield, Austin, Black, Taylor, & Altman, ; Harrison, Rossier, & Lemieux, ; Hinten et al., ; Johnson et al., ; Piantadosi et al., , ; Rossier et al., ); owning or being bitten by a cat or dog with POWV antibodies (2/22) (Mahdy, Bansen, & McLaughlin, ; Wilson, Wherrett, & Mahdy, ); owning a cat infested with ticks (1/22) (Mahdy, Wilson, Wherrett, & Dorland, ); having close contact with a dog that frequently chased forest rodents (1/22) (Joshua, ); working in basements with uncertain rodents and bat exposures (1/22) (Piantadosi et al., ); and handling a recently deceased woodchuck (1/22) (Embil, Camfield, Artsob, & Chase, ).…”

“…Following POWV infection, several long‐term sequelae were reported across 28 studies. The most commonly noted persistent symptoms were neurological issues (10/28), generalized weakness (7/28 studies), cognitive difficulties (7/28), speech difficulties (7/28), imbalance and difficulty walking (7/28) spastic quadriplegia (4/28), ophthalmoplegia (4/28) and headaches (4/28) (Camfield, Mehrmanesh, & Embil, ; Cavanaugh et al., ; Conway & Rossier, ; Courtney et al., ; El Khoury, Camargo, White, et al., ; El Khoury, Hull, et al., Fitch & Artsob, ; Gholipour, Thon, Bevers, Henderson, & Feske, ; Goldfield et al., ; Granger et al., ; Harrison et al., ; Hicar, Edwards, & Bloch, ; Hinten et al., ; Jackson, ; Lessell & Collins, ; Mahdy et al., , ; Mittal, Hassan, Sanchez, & Robertson, ; Partington, Thomson, & O'Shaughnessy, ; Piantadosi et al., , ; Raval et al., ; Shah & Elkhoury, ; Smith et al., ; Sung et al., ; Trépanier et al., ; Tutolo et al., ; Wilson et al., ). Various combinations of symptoms have been reported from both adults and children diagnosed with POWV and there does not appear to be case attributes that would aid in predicting symptoms or severity of POWV disease.…”

“…The time between exposure and viremia was reported as 1–6 days (Mahdy et al., ), 2–3 weeks (El Khoury, Camargo, White, et al., ; Mahdy et al., ) and 35 days (El Khoury, Hull, et al., ). The time between exposure and symptoms occurring was reported to be 9 (Joshua, ), 14 (Centers for Disease Control and Prevention (CDC), ), 30 (Trépanier et al., ) and 34 days (Rossier et al., ) in four separate cases.…”