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West Nile Virus Neuroinvasive Disease: Lessons From Two Cases
Arens Taga1, Angeliki Filippatou, Sai Sachin Divakaruni
1Department of Neurology, Johns Hopkins University, Baltimore, MD.
The Neurologist
|October 1, 2024
Summary
West Nile neuroinvasive disease (WNND) can present with coma and thalamic lesions, posing diagnostic challenges. Early consideration of WNND is crucial for patients with unexplained altered mental status in endemic areas.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroimaging
Background:
- West Nile neuroinvasive disease (WNND) presents with diverse clinical manifestations affecting the central and peripheral nervous systems.
- Prolonged unresponsiveness is a common initial symptom of WNND.
Observation:
- Two cases of WNND are presented, characterized by coma and bilateral thalamic lesions on MRI.
- These cases highlight diagnostic difficulties in evaluating coma and WNND.
Findings:
- Diagnosing WNND requires a high index of suspicion, especially in elderly or immunocompromised individuals.
- Brain and spine MRI aid in differential diagnosis but can mimic other conditions.
- Cerebrospinal fluid serology is vital for WNND confirmation but has limitations.
Implications:
- WNND should be considered in patients with unexplained altered mental status in endemic regions during late summer and early fall.
- Prompt diagnosis and management are critical for improving patient outcomes.
- Further research may improve diagnostic accuracy and treatment strategies for WNND.
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