Journal of NeuroVirology

, Volume 23, Issue 1, pp 158–159 | Cite as

Adult-onset opsoclonus-myoclonus syndrome due to West Nile Virus treated with intravenous immunoglobulin

  • Julien Hébert
  • David Armstrong
  • Nick Daneman
  • Jennifer Deborah Jain
  • James PerryEmail author
Case Report


A 63-year-old female with no significant past medical history was presented with a 5-day history of progressive opsoclonus-myoclonus, headaches, and fevers. Her workup was significant only for positive West-Nile Virus serum serologies. She received a 2-day course of intravenous immunoglobulin (IvIG). At an 8-week follow up, she had a complete neurological remission. Adult-onset opsoclonus-myoclonus syndrome is a rare condition for which paraneoplastic and infectious causes have been attributed. To our knowledge, this is the first case reported of opsoclonus-myoclonus secondary to West-Nile Virus treated with intravenous immunoglobulin monotherapy.


Opsoclonus-myoclonus syndrome West Nile virus 



The authors would like to thank the patient for her collaboration with the publication of this case report.

Compliance with ethical standards

Financial Disclosure/Conflict of Interest concerning the research related to the manuscript

The authors declare that they have no conflict of interest.

Authors Roles

Julien Hébert: Writing of the first draft

David Armstrong: Production of videos

Nick Daneman: Review and critique of manuscript

Jennifer Jain: Review and critique of manuscript

James Perry: Review and critique of manuscript

Supplementary material

Video 1

The first part of the video shows the clinical findings of this patient at presentation. Significant opsoclonus is first demonstrated in all directions of gaze. Myoclonus of the hands and mouth can be observed. In the second part of the video, we can appreciate that the patient has achieved a full neurological recovery. Standing up from a chair, tandem gait, and extra-ocular movements are normal. (MPG 44386 kb)


  1. Afzal A, Ashraf S, Shamin S (2014) Opsoclonus myoclonus syndrome: an unusual presentation for West Nile virus encephalitis. Proc (Baylor Univ Med Cent) 27(2):108–110Google Scholar
  2. Alshekhlee A, Sultan B, Chandar K (2006) Opsoclonus persisting during sleep in West Nile encephalitis. Arch Neurol 63:1324–1326CrossRefPubMedGoogle Scholar
  3. Bîrlutiu V, Bîrlutiu RM (2014) Opsoclonus-myoclonus syndrome attributable to West Nile encephalitis: a case report. J Med Case Rep 8:232CrossRefPubMedPubMedCentralGoogle Scholar
  4. Cooper CJ, Said S (2014) West Nile virus encephalitis induced opsoclonus-myoclonus syndrome. Neurol Int 6:5359CrossRefPubMedPubMedCentralGoogle Scholar
  5. Davis LE, DeBiasi R, Goade DE et al (2006) West Nile Virus neuroinvasive disease. Ann Neurol 60(3):286–300CrossRefPubMedGoogle Scholar
  6. Dropcho EJ, Kline LB, Riser J (1993) Antineuronal (anti-Ri) antibodies in a patient with steroid-responsive opsoclonus-myoclonus. Neurology 43(1):207–211CrossRefPubMedGoogle Scholar
  7. Kapoor H, Signs K, Somsel P et al (2004) Persistence of West Nile Virus (WNV) IgM antibodies in cerebrospinal fluid from patients with CNS disease. J Clin Virol 31(4):289–291CrossRefPubMedGoogle Scholar
  8. Khosla JS, Edelman MJ, Kennedy N, Reich SG (2005) West Nile virus presenting as opsoclonus-myoclonus cerebellar ataxia. Neurology 64:1095CrossRefPubMedGoogle Scholar
  9. Klaas JP, Ahlskog JE, Pittock SJ et al (2012) Adult-onset myoclonus-opsoclonus syndrome. Arch Neurol 69(12):1598–1607CrossRefPubMedGoogle Scholar
  10. Morales-Bricenco H, Rodriguez-Violante M, Cervantes-Arriage A et al (2012) Opsoclonus-myoclonus syndrome associated with GQ1b antibodies. Mov Disord 27:1615–1616CrossRefGoogle Scholar
  11. Sayao AL, Suchowersky O, Al-Khataami A et al (2004) Calgary experience with West Nile virus neurological syndrome during the late summer of 2003. Can J Neurol Sci 31(2):194–203CrossRefPubMedGoogle Scholar

Copyright information

© Journal of NeuroVirology, Inc. 2016

Authors and Affiliations

  • Julien Hébert
    • 1
  • David Armstrong
    • 2
  • Nick Daneman
    • 3
    • 4
  • Jennifer Deborah Jain
    • 5
  • James Perry
    • 5
    Email author
  1. 1.Division of NeurologyUniversity of TorontoTorontoCanada
  2. 2.Faculty of MedicineUniversity of TorontoTorontoCanada
  3. 3.Division of Infectious DiseasesSunnybrook Health Sciences CenterTorontoCanada
  4. 4.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  5. 5.Division of NeurologySunnybrook Health Sciences CenterTorontoCanada

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