Department of Neurology, Johns Hopkins University, Baltimore, MD.
Neurologist. 2024 Nov 1;29(6):356-360. doi: 10.1097/NRL.0000000000000584.
West Nile neuroinvasive disease (WNND) displays a wide range of clinical manifestations due to its involvement of various structures within the central nervous system and peripheral nervous system, often including prolonged unresponsiveness as the presenting symptom.
We describe 2 patients presenting with coma and bilateral thalamic lesions on brain magnetic resonance imaging, found to have WNND after extensive workup. These cases illustrate some of the challenges associated with evaluating coma in general and specifically in diagnosing WNND.
The clinical diagnosis of WNND requires a high index of suspicion, particularly in immunocompromised and elderly patients. Brain and spine magnetic resonance imaging findings can help narrow down the differential diagnosis, although other diseases may manifest similarly. Serological studies on the cerebrospinal fluid are essential to confirm the diagnosis but have inherent limitations. Given these challenges, WNND should be considered in all patients living in endemic areas who present with unexplained altered mental status during the late summer and early fall seasons.
西尼罗河神经侵袭性疾病（WNND）由于涉及中枢神经系统和外周神经系统的各种结构，常表现为长时间的无反应，因此临床表现多样。
我们描述了 2 例以昏迷和双侧丘脑病变为表现的患者，经广泛检查后发现患有 WNND。这些病例说明了评估昏迷一般情况下，特别是诊断 WNND 时所面临的一些挑战。
WNND 的临床诊断需要高度怀疑，特别是在免疫功能低下和老年患者中。脑和脊柱磁共振成像发现有助于缩小鉴别诊断范围，尽管其他疾病也可能表现相似。脑脊液的血清学研究对于确诊至关重要，但存在固有局限性。鉴于这些挑战，在夏末初秋季节出现不明原因的精神状态改变的所有居住在流行地区的患者中，都应考虑 WNND 的可能性。
