Objective: To demonstrate a case of acute Parkinsonism caused by West Nile Virus (WNV) Encephalitis that improved with resolution of the infection.

Background: Acute onset Parkinsonism has a variety of causes including dopamine antagonists, strokes and viral causes including flaviviruses such as WNV, St. Louis encephalitis and Japanese encephalitis, and influenza.

Method: History, Physical Exam, laboratory studies and MRI.

Results: A healthy, well-functioning 79-year-old male with PMH of MCI, OSA presented with dramatic right sided tremor, fever, encephalopathy and meningismus. No previous hx of movement disorders were noted. Physical exam revealed bilateral upper extremity cog-wheel rigidity, narrow-based gait with decreased arm swing, 4-step turn, prominent right-sided resting tremor that was made worse with walking, facial tremor, bradykinesia with decrement on finger tapping, frontal release signs and myoclonus. MRI showed white matter disease consistent with chronic small vessel disease. CSF studies showed a pleocytosis with monocyte predominance, elevated protein and WNV IgM indicating an acute infection. During his hospital course, the Parkinsonism started to show improvement. We followed up via phone 5 months after the patient’s hospitalization. The patient reported continued improvement in his tremor with a minor residual postural tremor, resolution of the myoclonus and improvement in his gait. However, he continues to have difficulty functioning at his prior level due to bradykinesia. He also reported worsening of his preexisting mild cognitive impairment.

Conclusion: Viral induced Parkinsonism has been previously ascribed to a variety of viruses including WNV[1] [2] [3]. One case in 2003 described two relatively healthy patients who developed an acute encephalitis and concurrent parkinsonism that resolved with resolution of the disease[2]. St. Louis Encephalitis virus has also been documented to cause a transient Parkinsonism[1] [4]. While a rare cause of Parkinsonism, WNV should be suspected in cases of acute onset PD that occurs during or after a febrile illness. Further investigation is required to determine the incidence, predisposing factors and the likelihood of developing idiopathic Parkinson’s disease.

References: Jang H, Boltz DA, Webster RG, Smeyne RJ. (2009). Viral parkinsonism. Biochim Biophys Acta. 1792(7):714-21. Robinson RL, Shahida S, Madan N, Rao S, Khardori N. (2003). Transient parkinsonism in West Nile virus encephalitis. American Journal of Medicine 15(3):252-3. Solomon T, Fisher AF, Beasley DWC, Mandava P, Granwehr BP, Langsjoen H, Tracassos RD, Barrett, ADT, Resh, RB. (2003). Natural and Nosocomial Infection in a patient with West Nile Encephalitis and Extrapyramidal Movement Disorders. Clinical Infectious Disease 36:e140-5. Wasay M, Diaz-Arrastia R, Suss RA, Kojan S. Haq A, Burns D, Ness PV. (2000). St. Louis Encephalitis A Review of 11 cases in a 1995 Dallas, Tex, Epidemic. 57:114-118.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-onset-parkinsonism-secondary-to-west-nile-virus-encephalitis/