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Asymmetric Flaccid Paralysis: A Neuromuscular Presentation of West Nile Virus Infection
Ann Neurol 53:703-710,691, Li,J.,et al, 2003
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Article Abstract
The neuromuscular aspects of West Nile virus (WNV) infection have not been characterized in detail. We have studied a group of six patients with proven WNV infection. All cases presented with acute, severe, asymmetric, or monolimb weakness, with minimal or no sensory disturbance after a mild flu-like prodrome. Four cases also had facial weakness. Three of our cases had no encephalitic signs or symptoms despite cerebrospinal fluid pleocytosis. Electrophysiological studies showed severe denervation in paralyzed limb muscles, suggesting either motor neuron or multiple ventral nerve root damage. This localization is supported further by the finding of abnormal signal intensity confined to the anterior horns on a lumbar spine magnetic resonance imaging. Muscle biopsies from three patients showed scattered necrotic fibers, implicating mild direct or indirect muscle damage from the WNV infection. In summary, we describe a group of patients with acute segmental flaccid paralysis with minimalor no encephalitic or sensory signs. We have localized the abnormality to either the spinal motor neurons or their ventral nerve roots. It will be important for physicians to consider WNV infection in patients with acute asymmetric paralysis with or without encephalitic symptoms.
Related Tags
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anterior horn cell disease
arm weakness
central nervous system,infection of
flaccid paralysis
flu-like illness
leg weakness,unilateral
motor neuron disease
MRI,spinal cord
MRI,spinal cord,increased intramedullary cord signal
muscle biopsy
pleocytosis of cerebrospinal fluid
poliomyelitis-like illness
viral infection
viral infection,CNS
West Nile fever

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