title: Neuropathology of the brain and spinal cord in human West Nile virus infection.
abstract: OBJECTIVE
  To describe the histopathology of the brain and spinal cord in human West Nile virus (WNV) infection.
  
  
  METHODS
  Single case report, including premortem clinical and laboratory findings, and autopsy.
  
  
  RESULTS
  An 83-year-old female presented with acute confusion, high fevers, dysarthria and generalized subjective weakness, with decreased deep tendon reflexes and weakness on physical examination. Electromyography showed evidence of a sensorimotor axonal polyneuropathy of the right-sided extremities. She became ventilator-dependent and died after a 2-week ICU stay, following withdrawal of life support. WNV infection was confirmed premortem by detection of IgM antibodies from serum and CSF and postmortem by RT-PCR from brain tissue. Examination of the brain parenchyma showed scattered microglial aggregates accompanied by perivascular chronic inflammation. The leptomeninges showed focal lymphocytic infiltrates. Examination of the spinal cord showed lymphocytic infiltrates in nerve roots and within the cord proper, with focal microglial nodules and neuronophagia in the ventral horns. Special stains were negative for a demyelinating process. General autopsy revealed only emphysema and atelectasis.
  
  
  CONCLUSIONS
  The findings in this case suggest direct viral infection of the spinal cord and nerve roots as the mechanism of the flaccid paralysis often observed in patients infected with WNV. Findings are reviewed in comparison with other reports of neuropathologic findings in human WNV infection.
authors.affiliation: Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA. bouffardj@afip.osd.mil
authors.forename: J P
authors.initials: JP
authors.lastname: Bouffard
authors.forename: M A
authors.initials: MA
authors.lastname: Riudavets
authors.forename: R
authors.initials: R
authors.lastname: Holman
authors.forename: E J
authors.initials: EJ
authors.lastname: Rushing
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002490:Central Nervous System / Q000473:pathology / Q000821:virology*; D018792:Encephalitis, Viral / Q000473:pathology* / Q000821:virology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009187:Myelitis / Q000473:pathology* / Q000821:virology; D014901:West Nile Fever / Q000473:pathology*