title: The natural history of West Nile virus infection presenting with West Nile virus meningoencephalitis in a man with a prolonged illness: a case report.
abstract: BACKGROUND
  Estimates indicate that West Nile virus infects approximately one and a half million people in the United States of America. Up to 1% may develop West Nile virus neuroinvasive disease, in which infected patients develop any combination of meningitis, encephalitis, or acute paralysis.
  
  
  METHODS
  A 56-year-old African-American man presented to our hospital with headache, restlessness, fever, myalgias, decreased appetite, and progressive confusion. A cerebrospinal fluid examination showed mild leukocytosis and an elevated protein level. Testing for routine infections was negative. Brain T2-weighted magnetic resonance imaging scans showed marked enlargement of caudate nuclei and increased intensity within the basal ganglia and thalami. A West Nile virus titer was positive, and serial brain magnetic resonance imaging scans showed resolving abnormalities that paralleled his neurological examination.
  
  
  CONCLUSIONS
  This report is unusual as it portrays the natural history and long-term consequences of West Nile virus meningoencephalitis diagnosed on the basis of serial brain images.
authors: Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA. mlevin@uthsc.edu.
authors: Shraddha
authors: S
authors: Mainali
authors: Mansoor
authors: M
authors: Afshani
authors: James B
authors: JB
authors: Wood
authors: Michael C
authors: MC
authors: Levin
references: J Infect Dis. 2010 Jan 1;201(1):2-4
references: 19961306
references: JAMA. 2008 May 14;299(18):2135-6
references: 18477774
references: Mayo Clin Proc. 2006 Jan;81(1):12-6
references: 16438473
references: Med Clin North Am. 2008 Nov;92(6):1307-22, ix
references: 19145778
references: N Engl J Med. 2001 Jun 14;344(24):1807-14
references: 11407341
references: N Engl J Med. 2004 Jul 22;351(4):370-8
references: 15269317
references: Emerg Infect Dis. 2007 Mar;13(3):479-81
references: 17552106
references: N Engl J Med. 2001 Jun 14;344(24):1858-9
references: 11407349
references: Ann Neurol. 2006 Sep;60(3):286-300
references: 16983682