Amer Alshekhlee1, Badr Sultan, Krishan Chandar. 1. Department of Neurology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA. amer.alshekhlee@uhhs.com
Abstract
BACKGROUND: Recent outbreaks of West Nile virus infection have alerted the public to disabling paralysis as an outcome. Ocular motor involvement with West Nile virus is rare. OBJECTIVE: To describe a patient with West Nile virus encephalitis that resulted in opsoclonus-myoclonus syndrome with persistent ocular oscillation on electroencephalography during stage 2 sleep. PATIENT: A 53-year-old man who presented with viral prodrome followed by intense vertigo and encephalopathy. In addition to multifocal myoclonic jerks in the extremities, his eye movements were disrupted by bursts of high-frequency, conjugate ocular oscillations that occurred in random directions. RESULTS: Electroencephalography showed eye movement artifacts during the awake state and stage 2 sleep. Opsoclonus-myoclonus syndrome remained disabling 3 months after onset but markedly improved 8 months after onset. CONCLUSIONS: West Nile virus is another cause of opsoclonus-myoclonus syndrome that can occur in conjunction with encephalitis. The presence of an eye movement artifact on results of electroencephalography during stage 2 sleep should raise suspicion for opsoclonus.
BACKGROUND: Recent outbreaks of West Nile virus infection have alerted the public to disabling paralysis as an outcome. Ocular motor involvement with West Nile virus is rare. OBJECTIVE: To describe a patient with West Nile virus encephalitis that resulted in opsoclonus-myoclonus syndrome with persistent ocular oscillation on electroencephalography during stage 2 sleep. PATIENT: A 53-year-old man who presented with viral prodrome followed by intense vertigo and encephalopathy. In addition to multifocal myoclonic jerks in the extremities, his eye movements were disrupted by bursts of high-frequency, conjugate ocular oscillations that occurred in random directions. RESULTS: Electroencephalography showed eye movement artifacts during the awake state and stage 2 sleep. Opsoclonus-myoclonus syndrome remained disabling 3 months after onset but markedly improved 8 months after onset. CONCLUSIONS:West Nile virus is another cause of opsoclonus-myoclonus syndrome that can occur in conjunction with encephalitis. The presence of an eye movement artifact on results of electroencephalography during stage 2 sleep should raise suspicion for opsoclonus.
Authors: Răzvan Alexandru Radu; Elena Oana Terecoasă; Amalia Ene; Ovidiu Alexandru Băjenaru; Cristina Tiu Journal: Front Neurol Date: 2018-10-16 Impact factor: 4.003