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Powassan Encephalitis: A Case Report from New York, USA
Danielle A Bazer1, Matthew Orwitz1, Nicholas Koroneos1
1Department of Neurology, The State University of New York Stony Brook, Renaissance School of Medicine, 101 Nicolls Road, HSC 12/20, Stony Brook, NY 11794, USA.
Case Reports in Neurological Medicine
|August 29, 2022
Summary
Powassan virus, a tick-borne flavivirus, can cause encephalitis in North America. Early diagnosis through serology is crucial for patients with altered mental status, even outside peak transmission seasons.
Area of Science:
- Neuroscience
- Infectious Diseases
- Virology
Background:
- Powassan virus is a tick-borne flavivirus endemic to North America.
- It is transmitted by Ixodes species, with groundhogs as a common host.
- The virus can cause central nervous system (CNS) encephalitis, with diagnosis often relying on serology.
Observation:
- A 62-year-year-old male presented with acute altered mental status, dysarthria, and facial droop following tick bites in December.
- Cerebrospinal fluid (CSF) analysis showed signs of inflammation, and brain MRI revealed a subacute stroke.
- Arbovirus panel testing confirmed Powassan virus IgM and polyvalent microsphere immunofluorescence assay reactivity.
Findings:
- The patient's presentation and diagnostic results confirmed Powassan virus encephalitis.
- Despite the typical summer/fall transmission peak, this case occurred in winter, highlighting year-round risk.
- The patient developed critical illness myopathy and respiratory failure, necessitating tracheostomy.
Implications:
- Powassan virus should be considered in unexplained altered mental status cases in Lyme-endemic areas, irrespective of season.
- Increased prevalence in the Midwest and Northeast US warrants heightened clinical suspicion.
- Prompt diagnosis and management are vital for improving patient outcomes and preventing severe neurological complications.
