Acute flaccid paralysis associated with West Nile virus: Motor and functional improvement in 4 patients

Abstract

Marciniak C, Sorosky S, Hynes C. Acute flaccid paralysis associated with West Nile virus: motor and functional improvement in 4 patients. Objective To describe motor and functional recovery in 4 patients with acute flaccid paralysis associated with West Nile virus (WNV) infection. Design A case series describing patient clinical features at admission to rehabilitation through 6-month follow-up. Setting Academic acute free-standing inpatient rehabilitation hospital. Participants The patients (3 men, 1 woman; age range, 29–72y) with central nervous system WNV infection presented on rehabilitation admission, 18 to 112 days after onset of symptoms, with severe flaccid asymmetric weakness without sensory loss, and decreased functional independence. Electrodiagnostic studies demonstrated a severe diffuse motor axonopathy consistent with an anterior myelitis. Intervention Acute inpatient rehabilitation program over a period of 35 to 106 days. Main outcome measures Motor and FIM instrument scores at admission to rehabilitation, discharge, and 6-month follow-up. Results All patients showed modest improvements in strength and function; no patient made full recovery of strength or became ambulatory by 6-month follow-up. Conclusions Little is known about recovery in patients with WNV-associated anterior myelitis. It will be important to document any further improvements in strength and function in such patients over a longer follow-up period.