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Abstract Details

Opsoclonus-myoclonus Syndrome associated with West Nile Encephalitis
Infectious Disease
P10 - Poster Session 10 (5:30 PM-6:30 PM)
13-001
To recognize the presentation of opsoclonus-myoclonus syndrome (OMS) in the setting of West Nile encephalitis
Opsoclonus-myoclonus syndrome (OMS) is a rare autoimmune condition triggered by paraneoplastic or infectious causes and manifests as opsoclonus, myoclonic jerks, behavioral disturbances and ataxia.
Clinical Case description
A 72 year old male with a medical history rheumatoid arthritis on methotrexate presented to the hospital with headache, fever, sore throat and severe malaise for several days. His vital signs were significant for a temperature of 102.8F and mild tachycardia. His initial neurologic exam revealed an intact mentation and no focal deficits. A respiratory virus panel was positive for enterovirus and  he was treated with empiric antibiotics due to suspicion for underlying pneumonia in the setting of sepsis. Over the following 24 hours, he became obtunded with nuchal rigidity and his cerebrospinal fluid (CSF) revealed an elevated protein of 149 (14-45mg/dl), neutrophillic predominant cell count of 134 (0-5/uL) and the presence of West Nile antibodies. Antibiotics were discontinued and his mental status improved with supportive care. A repeat neurological assessment demonstrated opsoclonus, action myoclonus in his extremities, mild intention tremors and negative myoclonus in his legs upon standing. He required assistance to maintain his balance and had an ataxic gait with no appendicular overshooting. An MRI brain and electroencephalogram showed no abnormalities. The patient  was treated with 5 days of intravenous immunoglobulins (IVIG) with resolution of his opsoclonus along with marked reduction in his myoclonic jerks and improved gait ataxia—he was able to use a walker independently upon discharge.

This case adds to the published compendium of opsoclonus-myoclonus syndrome associated with West Nile encephalitis. Though there are no definitive treatments for OMS, we demonstrate, in this case, the therapeutic role of IVIG in hastening neurological recovery.

Authors/Disclosures
Neisha Patel, MD (Westchester Medical Center)
PRESENTER 		Dr. Patel has nothing to disclose.
Arpan Patel, MBBS (University of Kansas Medical Center) Dr. Patel has nothing to disclose.
Alanna Balbi, MD Dr. Balbi has nothing to disclose.
Ritesh Ramdhani, MD (Northwell Health) Dr. Ramdhani has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Encora Therapeutics. Dr. Ramdhani has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Encora Therapeutics. The institution of Dr. Ramdhani has received research support from NIH. Dr. Ramdhani has received research support from Parkinson Alliance. Dr. Ramdhani has received intellectual property interests from a discovery or technology relating to health care.