Poster 161: Axonal neuropathy of the extremities after West Nile virus: a case report.

Abstract

Setting: Free-standing rehabilitation hospital. Patient: A 69-year-old white man. Case Description: The patient was admitted to inpatient rehabilitation after being diagnosed with West Nile virus (WNV) infection. He initially presented to acute care with weakness, fatigue, elevated body temperature. His cerebrospinal fluid was positive for WNV. On initial examination, he had less than antigravity strength in both lower extremities and proximally in the upper extremities. Distal upper-extremity strength was 3/5. He was hyporeflexic and had normal sensation to light touch and proprioception. The patient’s higher-level cognitive and communication skills were within full limits and he was continent to bowel and bladder. He required total assistance for all transfers and toileting. Results: Nerve conduction and electromyography studies were done for the right median, ulnar, deep peroneal, tibial, and sural nerves. The electrodiagnostic findings were consistent with significant axonal neuropathy involving the upper and lower extremities. The patient was discharged after 21/2 months of inpatient rehabilitation. At this time, his strength had improved by 1 grade to 3/5 in the lower and proximal upper-extremities. Distal upper-extremity strength was 4/5. The patient needed maximal assistance with transfers and standing in parallel bars, moderate assistance with lower-body bathing, and minimal assistance with upper-body dressing. He was independent with grooming. Discussion: This is a rare case of WNV infection with axonal neuropathy and no cognitive deficits. Conclusion: Functional recovery of patients with WNV presenting with axonal neuropathy is slower compared with those presenting with encephalitis.