WNE, West Nile Encephalitis

Clinic

• 80% of WNV show no symptoms
• Mostly they recover completely, though Fatigue / Weakness may last for Weeks / Months.
• Symptoms may range from mild, such as fever, to severe, such as paralysis and meningitis.
• Sever infection can rarely cause permanent brain damage.
• The most common neuromuscular manifestation is a poliomyelitis syndrome with or without brain-stem involvement and respiratory failure.

Entities

• Poliomyelitis / GBS / LMN: Asymmetrical flaccid Paralysis (Monoparesis, Hemiparesis, Quadriparesis)
• Significant neurological deficit in 93% (49% Weakness, 35% Tremor and 16% Cranial neuropathy).
• Encephalitis
  • Mild confusion / Deep coma
  • Behavioural changes (Like Hysteria)
  • Convulsions
  • Depression

• Myositis
• Polyradiculitis / Brachial plexopathy
• Spinal sympathetic ganglianopathy (Autonomic instability: Rapid pulse, Flushed Face, Coldness of feet)
• Parkinsonism
  • Tremor
  • Bradykinesia
  • Rigidity / Spasm / Stiffness
  • Ataxia /Postural instability
• Meningitis: Headache; retro-orbital
• Eye Pain. Injected
• Optic neuritis
• Pharyngitis: Rawness, Sore throat, Cervical lymphadenopathy
• Myocarditis: Palpitation

• Splenomegaly: Leukopenia
• Hepatitis: Hepatomegaly, Nausea, Vomiting, Loss of appetite, and Diarrhea
• Pancreatitis: Diarrhea

• Eruptions: maculopapular, pale roseolar
• Hyponatremia
• Lying in bed agg. Night agg

WNND

• West Nile Neuroinvasive Disease occurs in less than 1% of cases, resulting in meningitis, encephalitis, meningoencephalitis or a poliomyelitis-like syndrome.
• Often there is normal neuroimaging, although abnormalities including basal ganglia, thalamus, cerebellum, and brain-stem have been reported
• Muscular weakness + Lower motor neuron symptoms, Flaccid paralysis, + Hyporeflexia +No sensory abnormalities.

WNP

• West Nile Poliomyelitis is an acute flaccid paralysis syndrome associated with WNV
• It is less common than WNM or WNE.
• It is generally characterized by the acute onset of Asymmetric limb weakness or paralysis in the absence of sensory loss.
• Pain sometimes precedes the paralysis. The paralysis can occur in the absence of fever, headache, or other common symptoms associated with WNV infection.
• Involvement of respiratory muscles, leading to acute respiratory failure, sometimes occurs.
• West-Nile reversible paralysis, Like WNP, the weakness or paralysis is asymmetric. Reported cases have been noted to have an initial preservation of deep tendon reflexes, which is not expected for a pure anterior horn involvement.
• Disconnect of upper motor neuron influences on the anterior horn cells possibly by myelitis or glutamate excitotoxicity have been suggested as mechanisms.

• Typical WNE paralysis is characterized by muscle weakness, decreased tone, and loss of deep tendon reflexes attributed to destruction of anterior horn cells.

Disease

• Myasthenia gravis
• Stiff-person syndrome
• Parkinson disease

Remedies

2. IOD, MERC. PHOS
3. Bell, Caust.  Cupr. Plb. Sil. Sulph.
4. agar, aur. Calc con gels kali-c