Acute Onset Parkinson's Disease Secondary to West Nile Virus Encephalitis

Home , Encephalitis

Graduate Medical Education Research Journal

Volume 2 Issue 1 Article 74

September 2020

Matthew V. Purbaugh University of Nebraska Medical Center

Fuad-al Ali University of Nebraska Medical Center

T. Scott Diesing University of Nebraska Medical Center

Amy Hellman University of Nebraska Medical Center

Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj

Part of the Higher Education Commons, and the Medicine and Health Sciences Commons

Recommended Citation Purbaugh, M. V., Ali, F., Diesing, T., , Hellman, A. Acute Onset Parkinson's Disease Secondary to West Nile Virus Encephalitis. Graduate Medical Education Research Journal. 2020 Sep 29; 2(1). https://digitalcommons.unmc.edu/gmerj/vol2/iss1/74

This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact [email protected]. Acute Onset Parkinson's Disease Secondary to West Nile Virus Encephalitis

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol2/iss1/74 *Names in bold type indicate presenting author.

SDS is associated with an increased risk of performed and demonstrated hypocellular adenovirus. He is now 6 years-old, fully developing myelodysplastic syndrome (MDS) bone marrow. Parents reported a history of engrafted, off immunosuppression, and and leukemia. Hematopoietic stem cell transfusion-independent. transplantation (HSCT) is the only curative treatment of bone marrow dysfunction in had an inconclusive genetic work-up but Conclusion: SDS. Indications for transplant include severe was clinically diagnosed with SDS. The Nebraska with SDS to receive a successful cytopenias, MDS, and leukemia. patient was weekly transfusions at 4 years- HSCT. Early recognition and diagnosis of the old. Due to his transfusion dependence, disease can decrease the incidence of MDS/ Methods: Bone Marrow Biopsy, Transplant. he was determined to be a candidate AML and transfusion-related complications. Consent was obtained to use this case for for HSCT. The patient received a novel In SDS patients who progress to transplant, educational purposes. reduced intensity conditioning followed by reduced intensity conditioning can decrease an allogeneic mismatched unrelated bone transplant-related morbidity and mortality and Results: A 2 month-old male presented marrow transplant. Complications following improve long-term quality of life. with pallor, diarrhea and anemia. He transplant included mucositis, moderate https://doi.org/10.32873/unmc.dc.gmerj.2.1.070 subsequently developed thrombocytopenia veno-occlusive disease, and disseminated and neutropenia. A bone marrow biopsy was

Acute Onset Parkinson’s Disease Secondary to West Nile Virus Encephalitis Matthew Purbaugh1, Fuad-al Ali1, T. Scott Diesing1, Amy Hellman1 1University of Nebraska Medical Center, Department of Neurological Sciences

Mentor: Amy Hellman resting tremor, facial tremor, bradykinesia of Parkinsonism, WNV should be suspected $ in cases of acute onset Parkinson's disease Program: Neurological Sciences myoclonus. MRI showed white matter disease (PD) that occurs during or after a febrile consistent with chronic small vessel disease. illness. Further investigation is required to Type: Case Report CSF showed pleocytosis with monocyte determine the incidence, predisposing factors predominance, elevated protein and WNV and the likelihood of developing idiopathic Background: Acute onset Parkinsonism IgM indicating an acute infection. The PD. has a variety of causes including dopamine Parkinsonism started to show improvement antagonists, strokes and viral causes $ https://doi.org/10.32873/unmc.dc.gmerj.2.1.090 !" improvement in his tremor with a minor encephalitis and Japanese encephalitis, and residual postural tremor, resolution of the References # myoclonus and improvement in his gait. He 1 Jang H, Boltz DA, Webster RG, Smeyne RJ. (2009). Viral parkinsonism. Biochim Biophys Acta. Methods: History, physical exam, laboratory 1792(7):714-21. prior level due to bradykinesia and worsening studies and MRI. 2 Robinson RL, Shahida S, Madan N, Rao S, Khardori of his preexisting MCI. N. (2003). Transient parkinsonism in West Nile Results: A healthy, well-functioning 79-year- virus encephalitis. American Journal of Medicine old male with PMH of MCI presented with Conclusion: Viral induced Parkinsonism 15(3):252-3. right sided tremor, fever, encephalopathy has been previously ascribed to a variety of 3 Solomon T, Fisher AF, Beasley DWC, Mandava P, viruses including WNV.1,2,3 One case in 2003 Granwehr BP, Langsjoen H, Tracassos RD, Barrett, and meningismus, with no previous history ADT, Resh, RB. (2003). Natural and Nosocomial of movement disorders. Physical exam described two relatively healthy patients Infection in a patient with West Nile Encephalitis revealed bilateral upper extremity cog-wheel who developed an acute encephalitis and and Extrapyramidal Movement Disorders. Clinical Infectious Disease 36:e140-5. rigidity, narrow-based gait with decreased concurrent parkinsonism that resolved with 2 arm swing, 4-step turn, prominent right-sided resolution of the disease. While a rare cause

Neuroinvasive West Nile Virus: A Case Series in Nebraska Matthew Purbaugh1, Erin Smith1, T. Scott Diesing1, Sachin Kedar1 1University of Nebraska Medical Center, Department of Neurological Sciences

Mentor: Sachin Kedar Methods: We reviewed charts of four patients falsely negative. Case 2: A 49-year-old admitted to neurology service who had female presented with left sided ptosis and Program: Neurological Sciences positive serology and/or polymerase chain $+$ reaction (PCR) testing for WNV. CSF lymphocytic pleocytosis and positive Type: Case Report WNV IgM. Case 3: A 79-year old male Results: Case 1: A 39-year-old female with presented with acute onset parkinsonism Background: Between May and October diffuse large B-cell lymphoma presented with positive CSF WNV IgM. Case 4: A 31 2018, there were 110 reported cases of year-old male who presented with uveo- neuroinvasive West Nile Virus (WNV) in paraplegia. MRI showed T2 hyperintensities meningitis syndrome with uveitis of the right Nebraska. The arbovirus can have many CNS involving the bilateral thalami, temporal lobes, eye, fever, headache, nuchal rigidity and manifestations including meningoencephalitis, midbrain, pons, and spinal cord which were CSF pleocytosis. An autoimmune cause was poliomyelitis like syndrome, and movement suspicious for CNS lymphoma. WNV was suspected until CSF showed WNV IgM. All disorders. We present four unusual $%&*$ four patients showed varying amounts of presentations of neuroinvasive WNV seen RCHOP made her serum and CSF serology neurological recovery with supportive care. during the summer of 2018.

Sept. 2020 | Vol. 2 | Issue 1 Poster Presentations 61