Poster 167: Initial and follow-up motor scores and functional status in patients with West Nile virus infection: a report of 4 cases.

Abstract

Setting: Acute inpatient rehabilitation hospital. Patients: 4 patients (age range, 29–72y) with West Nile virus (WNV) infection and weakness. Case Description: The patients presented to community hospitals with myalgia, headache, neck pain, weakness, areflexia, and normal sensation. All patients had positive titers for WNV in cerebrospinal fluid or serum. 2 patients had acute flaccid paraplegia; one received intravenous (IV) steroids without improvement. 2 patients presented with diffuse weakness and meningoencephalitis and required prolonged ventilatory support; 1 received IV gamma globulin without improvement. All patients were then transferred to an acute inpatient rehabilitation hospital. Assessment/Results: On admission, 2 patients had electrodiagnostic studies that revealed motor axonal loss without sensory abnormalities consistent with anterior horn cell involvement. Initial motor scores ranged from 30 to 66 with a mean of 43.5 (normal, 100). Initial score ranges on the FIM™ instrument ranged from 6 to 22 for self-care, 2 to 6 for sphincter control, 1 to 5 for mobility, 1 to 5 for wheelchair locomotion, 13 to 14 for communication, and 15 to 20 for cognition. All patients participated in comprehensive in- and outpatient rehabilitation programs. At 6-month follow-up, electrodiagnostic studies showed evidence of reinnervation in all 4 patients. Motor scores ranged from 32 to 70 (mean, 48.5). Follow-up FIM scores also showed modest improvements. In self-care, scores ranged from 10 to 37, with all patients showing increased independence. 2 patients were continent of bowel and bladder, and 2 patients were transferring independently. In locomotion, scores improved to a range of 6 to 8, however, no patients was ambulating independently. Communication and cognition were within normal limits. Discussion: WNV can cause severe neurologic disease, including acute flaccid paralysis and meningoencephalitis. There are limited data regarding functional recovery in such patients. Conclusions: Patients with WNV-associated weakness appear to make modest improvements in strength and function over time. Persistent weakness in the lower extremities limits ambulation skills at 6 months.