West Nile Neuroinvasive Disease Presenting as Elsberg Syndrome

The Neurologist
Maximiliano A HawkesAlejandro A Rabinstein

Abstract

Elsberg syndrome (ES) is a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis, mainly linked to reactivation, or occasionally primary, infection with herpes simplex virus type 2. West Nile virus neuroinvasive disease is rarely considered in the differential diagnosis of patients with ES. A 63-year-old man with pancreatic cancer in remission and polymyalgia rheumatica on low-dose prednisone presented with a 10-day history of low-back pain and a viral-type illness with low-grade fever, nausea, and vomiting. Days later, he developed left leg monoparesis, neurogenic bladder, and bowel. Magnetic resonance imaging of the lumbar spine revealed a hyperintense signal abnormality within the central spinal cord and conus medullaris with mild swelling of the conus. Cells, proteins, and glucose in cerebrospinal fluid were 67/mm, 70 mg/dL, and 58 mg/dL, respectively. Serology was positive for West Nile virus IgM. Nerve conduction studies and electromyography showed an acute motor neurogenic process affecting left lumbosacral segments. West Nile virus neuroinvasive disease is an uncommon condition that should be considered in patients with ES. Determining the etiology of ES in the acute setting may avoid unnecessary ...Continue Reading

References

Apr 1, 1978·Lancet·J K Oates, P R Greenhouse
Oct 27, 1977·The New England Journal of Medicine·L R CaplanS Berg
Aug 25, 2004·Neurology·O EberhardtM Weller
Jul 19, 2013·JAMA : the Journal of the American Medical Association·Lyle R PetersenRoger S Nasci
May 24, 2017·Neurology. Neuroimmunology and Neuroinflammation·Filippo SavoldiBrian G Weinshenker
Feb 13, 2018·Neurocritical Care·Maximiliano A HawkesAlejandro A Rabinstein

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Citations

Jul 12, 2019·Frontiers in Microbiology·María-Angélica Calderón-PeláezJaime E Castellanos
May 22, 2021·Journal of Clinical Neuromuscular Disease·Rory M C AbramsSusan C Shin

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