Is initial preservation of deep tendon reflexes in West Nile Virus paralysis a good prognostic sign?
Typical West Nile virus paralysis is characterized by muscle weakness, decreased tone, and loss of deep tendon reflexes attributed to destruction of anterior horn cells. Two cases in which deep tendon reflexes were initially preserved in the presence of profound and persistent muscle weakness are presented here. In both cases, deep tendon reflexes were later severely attenuated or lost, while weakness of the involved muscles remained profound and unchanged. Both patients showed good motor recovery at 6 months. Initial preservation of deep tendon reflexes in the presence of persistent muscle weakness indicates that in the early stages of disease, the muscle weakness in these two cases was not caused by destruction of anterior horn cells. Pathology involving anterior horns preceding AHC destruction could potentially disrupt upper motor neuron pathways to anterior horn cells, causing weakness with initial preserved deep tendon reflexes.
Department of Neurology, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas. USA.
Deb Kumar
DK
Mojumder
Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, Texas, USA.
Melina
M
Agosto
Department of Neurology, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas. USA.
Henrik
H
Wilms
Department of Neurology, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas. USA.
Jongyeol
J
Kim