Neurology: Case of the Month

Test Yourself — Patient 65

West Nile virus infection

1. Presence of the following is thought to be diagnostic of acute West Nile virus (WNV) infection:
   • [ A ] Cerebrospinal fluid (CSF) IgM antibodies against WNV
   • [ B ] Serum IgM antibodies against WNV
   • [ C ] Serum IgG antibodies against WNV
   • [ D ] A positive WNV plaque neutralization test on serum
   • [ E ] A and D
2. Other members of the same flavivirus family as West Nile virus (WNV), for which patient antibodies may cross react with WNV assays, include:
   • [ A ] St. Louis Encephalitis
   • [ B ] Japanese Encephalitis
   • [ C ] Eastern Equine Encephalitis
   • [ D ] A and B
3. Which of the following is LEAST likely to represent a neurologic complications of West Nile virus (WNV) infection?
   • [ A ] Meningoencephalitis
   • [ B ] Cranial nerve dysfunction
   • [ C ] Polyradiculitis
   • [ D ] Ataxia
   • [ E ] Myopathy
4. The Guillain-Barre-like syndrome associated with West Nile virus (WNV) infection is similar to classic Guillain-Barre syndrome, EXCEPT for the following:
   • [ A ] Elevated cerebrospinal fluid (CSF) protein
   • [ B ] Increased WBC count in the CSF
   • [ C ] Progressive weakness lacking significant sensory involvement beyond tingling
   • [ D ] The absence of deep tendon reflexes
5. All of the following have been documented as risk factors for increased mortality in West Nile virus (WNV) infection EXCEPT:
   • [ A ] Advanced age (i.e., over 75 years)
   • [ B ] Severely altered consciousness
   • [ C ] Coexisting HIV infection

 

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