Disclosures: Dylan W. Banks, MD: No financial relationships or conflicts of interest

Case Diagnosis: Neuroinvasive West Nile Virus

Case Description or Program Description: Following the increase in wet monsoons in 2021, Arizona has seen an unprecedented number of neuroinvasive West Nile Virus (WNV) infections. Arizona Department of Health reports indicate 488 cases of confirmed WNV with 113 fatalities in 2021. While the majority of WNV cases are self-limiting, less than 1% of cases are neuroinvasive resulting in encephalitis or meningitis. Even less frequently, anterior horn involvement of the spinal cord can result in a poliomyelitis like syndrome and varying degrees of myelopathy. This case series discusses the rehabilitation of 6 patients admitted to the neurorehabilitation unit (NRU) since 06/2021 with neuroinvasive WNV. Ages ranged from 51 to 84 years old. One patient was on immunosuppressants due to a history of liver transplant. All six patients required intubation during their hospital course. On admission to the NRU, patients had varying levels of functional impairment requiring minimal to maximal assistance. Manual muscle testing demonstrated a range of strength deficits from 0/5 incomplete quadriplegia to 5/5 strength but with severe deficits in functional mobility. Additionally, all patients had varying levels of encephalopathy with cognitive impairment. NRU admissions ranged from 11 to 69 days.

Setting: Acute Neurorehabilitation Unit

Assessment/Results: Patients were discharged home with varying levels of functional improvement, most frequently requiring minimal assistance. None of the patients reached a full recovery from myelopathic symptoms during their acute rehabilitation course. Slow cognitive improvement was noted for all patients. All patients were extubated and decannulated prior to discharge.

Discussion (relevance): The southwestern US has varying degrees of monsoon precipitation. This is the first case series looking at increases in WNV neurorehabilitation following Arizona’s 2021 monsoon season.

Conclusions: An increase in wet monsoons in 2021 in Arizona led to an increase in cases of neuroinvasive WNV requiring admission to the NRU.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rehabilitation-of-neuroinvasive-west-nile-virus-following-2021-arizona-monsoon-season-a-case-series/