Session Information
Date: Friday, November 15, 2019
Session Title: Neurological Rehabilitation Case Report
Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 4
Disclosures: Ryan Paul Nussbaum, DO: Nothing to disclose
Case Description: The patient underwent revision of liver transplant due to prior acute rejection. Six months following the second transplantation, she experienced high fevers, mental slowing, and rotary nystagmus. Cerebrospinal fluid studies demonstrated elevation in both West Nile AB IgG (1.46) and West Nile Ab IgM (6.11). Further ophthalmic evaluation showed bilateral bullous conjunctival chemosis and bilateral chorioretinitis. MRI of the brain revealed hyperintense T2 signal in the bilateral lentiform nuclei, substantia nigra, cerebellar folia and vermis, and corpus callosum while MRI spine demonstrated T2 signal at the anterior horns at cervical, thoracic, and conus medullaris regions. On admission to rehabilitation, she presented with poor balance, reduced strength in extremities, severe horizontal and vertical nystagmus, delayed cognitive processing, poor communication skills, hypophonia, inability to eat by mouth, and had a tracheostomy.
Setting: Inpatient Rehabilitation Hospital; Brain Injury Unit.
Patient: 25-year-old female with neuroinvasive West-Nile Virus (WNV) and history of liver transplant.
Assessment/Results: During 6 weeks of inpatient rehabilitation, she made the following FIM Gains on average per category: Self Care 1.33->2.66; Communication 1.5->4; Transfers 2.66->4; and Locomotion 1->3.5. In addition, she was decannulated and had her gastrostomy tube removed. She returned home with family who provided 24/7 supervision.
Discussion: In the USA, the incidence for neuroinvasive WNV in 2017 was 0.44 per 100,000. However, solid organ transplant recipients possess a 40-fold increased risk of contracting neuroinvasive WNV. Anatomically, areas commonly affected include basal ganglia, thalamus, brain stem, cerebellum, and ventral horns of spinal cord as well as conus medullaris/cauda equina. This case represents a successful rehabilitation course of an individual who developed this condition.
Conclusion: Clinicians should be mindful that individuals with solid organ transplantation are at higher risk for neuroinvasive WNV, and that the anatomy most often affected includes basal ganglia, thalamus, brain stem, cerebellum, and ventral horns of spinal cord.
Level of Evidence: Level V
To cite this abstract in AMA style:
Nussbaum RP, Hassaballa D. Benefits of Inpatient Rehabilitation for Patient with Rare Case of Neuroinvasive West Nile Virus and History of Liver Transplant [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/benefits-of-inpatient-rehabilitation-for-patient-with-rare-case-of-neuroinvasive-west-nile-virus-and-history-of-liver-transplant/. Accessed May 22, 2025.« Back to AAPM&R Annual Assembly 2019
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/benefits-of-inpatient-rehabilitation-for-patient-with-rare-case-of-neuroinvasive-west-nile-virus-and-history-of-liver-transplant/