Poster 24: Rehabilitation outcome of 2 patients with neurologic complications from West Nile virus: a report of 2 cases

Abstract

Setting: Inpatient rehabilitation. Patients: 2 patients with neurologic complications from West Nile virus (WNV). Case Description: A 42-year-old previously healthy man (patient 1) had an 82-day acute hospitalization with positive WNV serology and electromyography findings of severe generalized motor axonal and demyelinating polyneuropathy. Complications included flaccid quadraparesis, intubation, subsequent tracheostomy, pneumonia, and percutaneous endoscopic gastrostomy (PEG) placement. A 41-year-old man (patient 2), with remote history of traumatic brain injury, had a 5-day acute hospitalization with positive WNV serology, encephalitis, fever, mental status alteration, and mild quadraparesis. Assessment/Results: Patient 1 underwent a 57-day intensive interdisciplinary rehabilitation course notable for respiratory therapy, swallowing strategy instruction, and neurogenic bowel and bladder training. He showed improvement in grooming, feeding, and wheelchair ambulation. His tracheostomy and PEG were removed. He was discharged to an adult care facility with day rehabilitation follow-up at predominantly a dependent to maximum assistance level. At 7 months, he remained unchanged with the exception of a new tracheostomy placed due to respiratory failure from pneumonia. Patient 2 underwent a 6-day interdisciplinary rehabilitation course notable for cognitive neuropsychologic rehabilitation and physical and occupational therapy. He was discharged home at a modified independent level, which was his premorbid functional level. He remained at this level at 7-month follow-up. Discussion: Although WNV incidence increased in 2002, there have been few case reports on the rehabilitation management and outcomes of patients with complications resulting from WNV. These 2 patients with WNV required individualized rehabilitation approaches because of their varied neurologic and medical complications. They had significantly different functional outcomes. Conclusion: These 2 cases demonstrate the variable clinical presentations and outcomes resulting from complications attributed to WNV infections. Rehabilitation centers should recognize the need to personalize the rehabilitation process in WNV patients.