Case Report of Transient Acute Parkinsonism in the setting of West Nile Virus Encephalitis (P1.9-039)

Objective: Acute onset of Parkinsonism is an uncommon presentation to the emergency department, and is usually secondary to various conditions. These include but are not limited to: acute vascular pathology, structural lesions (e.g. obstructive hydrocephalus, pontine myelinolysis, etc.), medications, and viral infections. We present a case of acute Parkinsonism secondary to a viral infection. Background: NA Design/Methods: NA Results: A 56-year-old chef, with no prior history of movement disorders, presented to the hospital with ongoing confusion and tremors in both arms for one week. Two weeks prior to presentation, patient had a fever, vomiting and diarrhea, all of which had resolved. Neurologic examination was significant for impaired delayed recall, decreased attention, cogwheel rigidity in both arms along with a low amplitude, medium frequency resting, postural, and action tremors in both upper extremities, right greater than left. No gait abnormality was noted. Magnetic resonance imaging (MRI) of the brain was unremarkable. Cerebrospinal fluid analysis showed 31 leukocytes/mm (98% lymphocytes), a glucose level of 51 mg/dL, and a protein level of 98 mg/dL. Cerebrospinal fluid cultures for bacteria, viruses, and fungi were negative. West Nile Virus (WNV)–specific immunoglobulin (Ig) M was present on the New York State Encephalitis Panel. The patient was discharged home with supportive care. In ambulatory follow-up 3 weeks later, cognition and muscle tone were normal. Resting and action tremors had also resolved, however bilateral mild postural tremors persisted in the upper extremities, right greater than left. Conclusions: Most common viral encephalitis associated with acute Parkinsonism are WNV, Coxsackie virus, Japanese Encephalitis Virus, Influenza, and Human Immunodeficiency Virus. Acute onset of Parkinsonian features during WNV encephalitis likely follows the virus-induced death of dopaminergic neurons, resulting in the acute loss of dopamine signaling. We stress that viral etiologies such as WNV should be considered in a patient presenting with encephalopathy and acute Parkinsonism. Disclosure: Dr. Vanguru has nothing to disclose. Dr. Lopez has nothing to disclose. Dr. Gudlavalleti has nothing to disclose. Dr. Sanders has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with PsyBar, Dane Street, Professional Disability Associates, and Academic Insurance.