Journal of NeuroVirology

, Volume 16, Issue 1, pp 93–100

Delayed-onset and recurrent limb weakness associated with West Nile virus infection

  • James J. Sejvar
  • Larry E. Davis
  • Erica Szabados
  • Alan C. Jackson
Case Report


Human neurologic illness following infection with West Nile virus (WNV) may include meningitis, encephalitis, and acute flaccid paralysis (AFP). Most WNV-associated AFP is due to involvement of the spinal motor neurons producing an anterior (polio)myelitis. WNV poliomyelitis is typically characterized by acute and rapidly progressing limb weakness occurring early in the course of illness, which is followed by death or clinical plateauing with subsequent improvement to varying degrees. We describe four cases of WNV poliomyelitis in which the limb weakness was characterized by an atypical temporal pattern, including one case with onset several weeks after illness onset, and three cases developing relapsing or recurrent limb weakness following a period of clinical plateauing or improvement. Delayed onset or recurrent features may be due to persistence of viral infection or delayed neuroinvasion with delayed injury by excitotoxic or other mechanisms, by immune-mediated mechanisms, or a combination thereof. Further clinical and pathogenesis studies are needed to better understand the mechanisms for these phenomena. Clinicians should be aware of these clinical patterns in patients with WNV poliomyelitis.


myelitis neuroinvasive disease poliomyelitis West Nile virus 


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Copyright information

© Journal of NeuroVirology, Inc. 2010

Authors and Affiliations

  • James J. Sejvar
    • 1
  • Larry E. Davis
    • 2
    • 3
  • Erica Szabados
    • 4
  • Alan C. Jackson
    • 5
  1. 1.Division of Viral and Rickettsial Diseases, Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vectorborne, and Enteric DiseasesCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Neurology ServiceNew Mexico VA Health Care SystemAlbuquerqueUSA
  3. 3.Department of NeurologyUniversity of New Mexico School of MedicineAlbuquerqueUSA
  4. 4.Department of Clinical Neurosciences (Neurology) (Clinical)Warren Alpert Medical School of Brown UniversityProvidenceUSA
  5. 5.Departments of Internal Medicine (Neurology) and of Medical MicrobiologyUniversity of ManitobaWinnipegCanada

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