WNE, West Nile Encephalitis: Difference between revisions

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*Symptoms may range from mild, such as fever, to severe, such as paralysis and meningitis.  
*Symptoms may range from mild, such as fever, to severe, such as paralysis and meningitis.  
*Sever infection can rarely cause permanent brain damage.
*Sever infection can rarely cause permanent brain damage.
*The most common neuromuscular manifestation is a [[poliomyelitis syndrome]] with or without [[Brainstem|brain-stem]] involvement and respiratory failure.
*The most common neuromuscular manifestation is a poliomyelitis syndrome with or without [[Brainstem|brain-stem]] involvement and respiratory failure.
*Significant neurological deficit in 93% (49% Weakness, 35% Tremor and 16% Cranial neuropathy).<ref>Hart, J., Tillman, G., Kraut, M.A. ''et al.'' West Nile virus neuroinvasive disease: neurological manifestations and prospective longitudinal outcomes. ''BMC Infect Dis'' '''14''', 248 (2014). <nowiki>https://doi.org/10.1186/1471-2334-14-248</nowiki></ref>




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Subhan Tabba, Asif Kabani
Subhan Tabba, Asif Kabani


Neurology May 2022, 98 (18 Supplement) 3438;</ref>/ [[GBS, Guillian Barre syndrome|GBS]] <ref name=":0" />/ [[LMN, Lower motor neuron entities|LMN]]: Asymmetrical [[Flaccid Paralysis miasms|flaccid Paralysis]] (Monoparesis, [[Hemiparesis miasms|Hemiparesis]], Quadriparesis)
Neurology May 2022, 98 (18 Supplement) 3438;</ref>/ [[GBS, Guillian Barre syndrome|GBS]] <ref name=":0" />/ [[LMN, Lower Motor Neuron|LMN]]: Asymmetrical [[Flaccid Paralysis miasms|flaccid Paralysis]] (Monoparesis, [[Hemiparesis miasms|Hemiparesis]], Quadriparesis)
*Significant neurological deficit in 93% (49% Weakness, 35% Tremor and 16% Cranial neuropathy).<ref>Hart, J., Tillman, G., Kraut, M.A. ''et al.'' West Nile virus neuroinvasive disease: neurological manifestations and prospective longitudinal outcomes. ''BMC Infect Dis'' '''14''', 248 (2014). <nowiki>https://doi.org/10.1186/1471-2334-14-248</nowiki></ref>
*[[Encephalitis]]
*[[Encephalitis]]
**Mild confusion / Deep coma
**Mild confusion / Deep coma
**Behavioural changes (Like Hysteria)
**Behavioral changes (Like [[Hysteria remedies|Hysteria]])
**[[Seizure|Convulsions]] <ref>https://www.encephalitis.info/</ref>  
**[[Seizure|Convulsions]] <ref>https://www.encephalitis.info/</ref>  
**[[Depression remedies|Depression]] <ref>Paul J. Carson, Patrick Konewko, Kimberly S. Wold, Paul Mariani, Sunil Goli, Paula Bergloff, Ross D. Crosby, Long-Term Clinical and Neuropsychological Outcomes of West Nile Virus Infection, ''Clinical Infectious Diseases'', Volume 43, Issue 6, 15 September 2006, Pages 723–730,</ref>
**[[Depression remedies|Depression]] <ref>Paul J. Carson, Patrick Konewko, Kimberly S. Wold, Paul Mariani, Sunil Goli, Paula Bergloff, Ross D. Crosby, Long-Term Clinical and Neuropsychological Outcomes of West Nile Virus Infection, ''Clinical Infectious Diseases'', Volume 43, Issue 6, 15 September 2006, Pages 723–730,</ref>
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<nowiki>https://doi.org/10.3389/fneur.2012.00037</nowiki></ref>
<nowiki>https://doi.org/10.3389/fneur.2012.00037</nowiki></ref>
* [[Polyradiculitis]] / [[Brachial plexus neuropathy|Brachial plexopathy]]  <ref name=":2">Madden K. West Nile virus infection and its neurological manifestations. Clin Med Res. 2003 Apr;1(2):145-50. doi: 10.3121/cmr.1.2.145. PMID: 15931302; PMCID: PMC1069038.</ref>
* [[Polyradiculitis]] / [[Brachial plexus neuropathy|Brachial plexopathy]]  <ref name=":2">Madden K. West Nile virus infection and its neurological manifestations. Clin Med Res. 2003 Apr;1(2):145-50. doi: 10.3121/cmr.1.2.145. PMID: 15931302; PMCID: PMC1069038.</ref>
*
* Spinal sympathetic ganglianopathy (Autonomic instability: Rapid pulse, Flushed Face, Coldness of feet) <ref>Budhram A, Sharma M, Shettar B, Hosseini-Moghaddam SM, Khaw AV. Sensory and autonomic involvement in West Nile virus-associated acute flaccid paralysis. Neurol Clin Pract. 2017 Oct;7(5):394-397. doi: 10.1212/CPJ.0000000000000373. PMID: 29620087; PMCID: PMC5874468.</ref>  
* Spinal sympathetic ganglianopathy (Autonomic instability: Rapid pulse, Flushed Face, Coldness of feet) <ref>Budhram A, Sharma M, Shettar B, Hosseini-Moghaddam SM, Khaw AV. Sensory and autonomic involvement in West Nile virus-associated acute flaccid paralysis. Neurol Clin Pract. 2017 Oct;7(5):394-397. doi: 10.1212/CPJ.0000000000000373. PMID: 29620087; PMCID: PMC5874468.</ref>  
* [[Parkinsonism]]  
* [[Parkinsonism]]  
** [[Tremor miasms|Tremor]]
** [[Tremor]] (35%)
** [[Bradykinesia miasms|Bradykinesia]]
** Bradykinesia
** [[Rigidity miasms|Rigidity]] / [[Spasm miasms|Spasm]]  / Stiffness
** [[Rigidity]] / [[Spasm]]  / Stiffness
**[[Ataxia]] /Postural instability
**[[Ataxia]] /Postural instability
* [[Meningitis]]: Headache; retro-orbital  
* [[Meningitis]]: Headache; retro-orbital  
* Eye Pain. Injected
* [[Optic neuritis]]
* [[Optic neuritis]]
* [[Pharyngitis]]: Rawness, Sore throat, Cervical lymphadenopathy
* [[Pharyngitis]]: Rawness, Sore throat, Cervical lymphadenopathy
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*Hyponatremia
*Hyponatremia
*Lying in bed agg. Night agg
*Lying in bed agg. Night agg
*Eye Pain. Injected




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* '''W'''est '''N'''ile '''N'''euroinvasive '''D'''isease occurs in less than 1% of cases, resulting in meningitis, encephalitis, [[Meningoencephalitis remedies|meningoencephalitis]] or a poliomyelitis-like syndrome.
* '''W'''est '''N'''ile '''N'''euroinvasive '''D'''isease occurs in less than 1% of cases, resulting in meningitis, encephalitis, [[Meningoencephalitis remedies|meningoencephalitis]] or a poliomyelitis-like syndrome.
* Often there is normal neuroimaging, although abnormalities including basal ganglia, thalamus, cerebellum, and brain-stem have been reported
* Often there is normal neuroimaging, although abnormalities including basal ganglia, thalamus, cerebellum, and brain-stem have been reported
* Muscular weakness + [[LMN, Lower motor neuron entities|Lower motor neuron symptoms]], Flaccid paralysis, + Hyporeflexia +No sensory abnormalities.<ref name=":3">Wikipedia</ref>
* Muscular weakness + [[LMN, Lower Motor Neuron|Lower motor neuron symptoms]], Flaccid paralysis, + Hyporeflexia +No sensory abnormalities.<ref name=":3">Wikipedia</ref>




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* Typical WNE paralysis is characterized by muscle weakness, decreased tone, and loss of deep tendon reflexes attributed to destruction of anterior horn cells.<ref>Mojumder DK, Agosto M, Wilms H, Kim J. Is initial preservation of deep tendon reflexes in West Nile Virus paralysis a good prognostic sign? Neurol Asia. 2014 Mar;19(1):93-97. PMID: 25400704; PMCID: PMC4229851.</ref>  
* Typical WNE paralysis is characterized by muscle weakness, decreased tone, and loss of deep tendon reflexes attributed to destruction of anterior horn cells.<ref>Mojumder DK, Agosto M, Wilms H, Kim J. Is initial preservation of deep tendon reflexes in West Nile Virus paralysis a good prognostic sign? Neurol Asia. 2014 Mar;19(1):93-97. PMID: 25400704; PMCID: PMC4229851.</ref>  


*


=== Disease ===
=== Disease ===


* Myasthenia gravis
* [[Myasthenia gravis]]
* [[Stiff person syndrome|Stiff-person syndrome]] <ref name=":1" />
* [[Stiff person syndrome|Stiff-person syndrome]] <ref name=":1" />
*[[Parkinson remedies|Parkinson]] disease
*[[Parkinson disease]]






=== Remedies ===
=== [[Homeopathic remedies|Remedies]] ===
#
#
# '''[[Iod, Iodium|IOD]], [[Merc, Mercurius Solubilis|MERC]].''' '''PHOS'''
# '''[[Iod, Iodium|IOD]], [[Merc, Mercurius Solubilis|MERC]].''' '''PHOS'''
# ''Bell,'' ''Caust.''  ''Cupr.'' ''Plb.'' ''Sil.'' ''Sulph.''
# Bell, Caust.  Cupr. Plb. Sil. Sulph.
# agar, aur. Calc con gels kali-c
# agar, aur. Calc con gels kali-c




<references />
<references />

Revision as of 07:09, 24 June 2023

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.
  • Significant neurological deficit in 93% (49% Weakness, 35% Tremor and 16% Cranial neuropathy).[1]


Entities

  • Splenomegaly: Leukopenia
  • Hepatitis: Hepatomegaly, Nausea, Vomiting, Loss of appetite, and Diarrhea
  • Pancreatitis: Diarrhea
  • Eruptions: maculopapular, pale roseolar
  • Hyponatremia
  • Lying in bed agg. Night agg
  • Eye Pain. Injected


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.[8]


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.[8]
  • Typical WNE paralysis is characterized by muscle weakness, decreased tone, and loss of deep tendon reflexes attributed to destruction of anterior horn cells.[9]


Disease


Remedies

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


  1. ↑ Hart, J., Tillman, G., Kraut, M.A. et al. West Nile virus neuroinvasive disease: neurological manifestations and prospective longitudinal outcomes. BMC Infect Dis 14, 248 (2014). https://doi.org/10.1186/1471-2334-14-248
  2. ↑ 2.0 2.1 A Wolf in Sheep’s Clothing: West Nile Virus presenting as Guillain Barre Variant (P11-9.005) Subhan Tabba, Asif Kabani Neurology May 2022, 98 (18 Supplement) 3438;
  3. ↑ https://www.encephalitis.info/
  4. ↑ Paul J. Carson, Patrick Konewko, Kimberly S. Wold, Paul Mariani, Sunil Goli, Paula Bergloff, Ross D. Crosby, Long-Term Clinical and Neuropsychological Outcomes of West Nile Virus Infection, Clinical Infectious Diseases, Volume 43, Issue 6, 15 September 2006, Pages 723–730,
  5. ↑ 5.0 5.1 REVIEW article Front. Neurol., 21 March 2012 Sec. Neuromuscular Disorders and Peripheral Neuropathies https://doi.org/10.3389/fneur.2012.00037
  6. ↑ Madden K. West Nile virus infection and its neurological manifestations. Clin Med Res. 2003 Apr;1(2):145-50. doi: 10.3121/cmr.1.2.145. PMID: 15931302; PMCID: PMC1069038.
  7. ↑ Budhram A, Sharma M, Shettar B, Hosseini-Moghaddam SM, Khaw AV. Sensory and autonomic involvement in West Nile virus-associated acute flaccid paralysis. Neurol Clin Pract. 2017 Oct;7(5):394-397. doi: 10.1212/CPJ.0000000000000373. PMID: 29620087; PMCID: PMC5874468.
  8. ↑ 8.0 8.1 Wikipedia
  9. ↑ Mojumder DK, Agosto M, Wilms H, Kim J. Is initial preservation of deep tendon reflexes in West Nile Virus paralysis a good prognostic sign? Neurol Asia. 2014 Mar;19(1):93-97. PMID: 25400704; PMCID: PMC4229851.
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