Leis A Arturo, Stokic Dobrivoje S, Webb Risa M, Slavinski Sally A, Fratkin Jonathan
Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson, Suite 2, Jackson, Mississippi 39216, USA.
Muscle Nerve. 2003 Sep;28(3):302-8. doi: 10.1002/mus.10440.
Poliomyelitis has recently been identified as a cause of muscle weakness in patients with West Nile virus (WNV) infection. However, the clinical spectrum of WNV-associated weakness has not been described. We reviewed data on 13 patients with WNV infection. Patients with muscle weakness were classified into one of three distinct groups based on clinical features. Group 1 comprised five patients who developed acute flaccid paralysis, four with meningoencephalitis and one without fever or other signs of infection. Paralysis was asymmetric, and involved from one to four limbs in individual patients. Electrodiagnostic studies confirmed involvement of anterior horn cells or motor axons. Group 2 involved two patients without meningoencephalitis who developed severe but reversible muscle weakness that recovered completely within weeks. Muscle weakness involved both lower limbs in one patient and one upper limb in the other. Group 3 consisted of two patients who experienced subjective weakness and disabling fatigue, but had no objective muscle weakness on examination. In addition to the three distinct groups, two other patients developed exaggerated weakness in the distribution of preexisting lower motor neuron dysfunction. We conclude that the clinical spectrum of WNV-associated muscle weakness ranges from acute flaccid paralysis, with or without fever or meningoencephalitis, to disabling fatigue. Also, preexisting dysfunction may predispose anterior horn cells to additional injury from WNV. Awareness of this spectrum will help to avoid erroneous diagnoses and inappropriate treatment.
脊髓灰质炎最近被确认为西尼罗河病毒（WNV）感染患者肌肉无力的一个病因。然而，WNV相关肌无力的临床谱尚未得到描述。我们回顾了13例WNV感染患者的数据。根据临床特征，肌无力患者被分为三个不同的组之一。第1组包括5例发生急性弛缓性麻痹的患者，4例患有脑膜脑炎，1例无发热或其他感染迹象。麻痹是不对称的，个别患者累及1至4个肢体。电诊断研究证实前角细胞或运动轴突受累。第2组包括2例无脑膜脑炎的患者，他们出现了严重但可逆的肌无力，在数周内完全恢复。肌无力在1例患者中累及双下肢，在另1例患者中累及1例上肢。第3组由2例经历主观无力和致残性疲劳但检查时无客观肌无力的患者组成。除了这三个不同的组外，另外2例患者在既往存在的下运动神经元功能障碍分布区域出现了过度无力。我们得出结论，WNV相关肌无力的临床谱范围从伴有或不伴有发热或脑膜脑炎的急性弛缓性麻痹到致残性疲劳。此外，既往存在的功能障碍可能使前角细胞更容易受到WNV的额外损伤。认识到这一谱将有助于避免错误诊断和不适当的治疗。
