42170. HEMIPARSIS IN A CHILD WITH WEST NILE VIRUS ENCEPHALITIS
Session: Poster Abstract Session: Medical Student Poster Session
Friday, October 4, 2013
Room: Yerba Buena Ballrooms
Posters
  • ID Week - West Nile Virus - Abstract #42170.pdf (502.0 kB)
  • Background: :  West Nile Virus Encephalitis (WNVE) in pediatric patients is typically a self-limited febrile illness without long-term neurologic consequences

    Methods:

    We report a case of hemiparesis in a 20 month old child with WNVE.

    Results: The patient was admitted to hospital with fevers of one week duration associated with cough rhinorrhea, and abdominal pain.  She had been seen by her primary care physician and had been placed on cefidir.  She presented with fever and lethargy, but no other neurologic symptoms prior to admission.  Initial Cerebral spinal fluid revealed a white blood cell count of 211cells/microliter with normal CSF glucose and protein.  Gram’s stain showed Gram negative rods. Forty-eight hours after admission she had left upper and lower extremity seizure activity.  She developed paralysis of the left upper and lower extremities, initially thought to be a Todd’s paralysis, but it persisted 3 weeks.  MRI revealed ischemic changes in the right and left thalamic nuclei and in the right basal ganglion.  MRA showed absence of one segment of the right middle cerebral artery, which, in retrospect, was determined to be a congenital variation of the cerebral arterial system.  She received three weeks of IV antibiotics.  Acyclovir was administered until Herpes studies were negative.  West Nile Virus antibodies for IgG and IGM were elevated in the CSF.  Serum titers were elevated for West Nile IgG and IgM. Eight months post hospitalization she appeared to be normal on physician exam.   

    Conclusion:

    This child was hospitalized during a West Nile virus outbreak in North Texas.  This is an unusual case of WNVE in a pediatric patient with resolution of neurologic symptoms.

    Mark Shelton, MD, Cook Children's Medical Center, Fort Worth, TX and Daniel Freedman, Medical School, University of North Texas Health Science Center, Fort Worth, TX

    Disclosures:

    M. Shelton, None

    D. Freedman, None

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