title: West Nile Meningoencephalitis Presenting as Isolated Bulbar Palsy With Hypercapnic Respiratory Failure: Case Report and Literature Review.
abstract: BACKGROUND
  Since the outbreak of West Nile virus (WNV) in the United States in 1999, the WNV neuroinvasive disease has been increasingly reported with a wide spectrum of neuromuscular manifestations.
  
  
  METHODS
  We submit a case of a 46-year-old male with a history of alcohol abuse, diabetes, hypertension, and hepatitis C who presented with fever, nausea, shortness of breath, and dysphagia. The patient rapidly developed hypercapnic respiratory failure and was found to have WNV meningoencephalitis without obvious neuromuscular weakness. His hospital course was significant for repeated failures of extubation secondary to persistent bulbar weakness eventually requiring tracheotomy.
  
  
  CONCLUSIONS
  This is a unique case of WNV meningoencephalitis with bulbar palsy without other neuromuscular manifestations resulting in recurrent hypercapnic respiratory failure.
authors.affiliation: Department of Medicine, Olive View-UCLA Medical Center, UCLA David Geffen School of Medicine, Sylmar, CA, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Tso
authors.affiliation: Department of Medicine, Olive View-UCLA Medical Center, UCLA David Geffen School of Medicine, Sylmar, CA, USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Kaldas
authors.affiliation: Department of Medicine, Olive View-UCLA Medical Center, UCLA David Geffen School of Medicine, Sylmar, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Springer
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Olive View-UCLA Medical Center, UCLA David Geffen School of Medicine, Sylmar, CA, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Barot
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Olive View-UCLA Medical Center, UCLA David Geffen School of Medicine, Sylmar, CA, USA kamangar@ucla.edu.
authors.forename: Nader
authors.initials: N
authors.lastname: Kamangar
mesh_terms: D010244:Bulbar Palsy, Progressive / Q000821:virology*; D006801:Humans; D006935:Hypercapnia / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000821:virology*; D014481:United States; D014901:West Nile Fever / Q000150:complications*; D014902:West Nile virus
keywords: West Nile virus; bulbar palsy; neuromuscular weakness; respiratory failure