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We report the first case of West Nile virus (WNV) encephalitis in which the only MRI abnormality during the initial phase of the infection was restriction in water mobility observed on diffusion-weighted imaging (DWI). The potential impact of hyperacute DWI in WNV encephalitis is discussed.
Case report.
A 58-year-old woman, 2 years after liver transplantation and taking 1.5 g mycophenolate mofetil and 200 mg cyclosporine daily, was admitted with fever and myoclonic jerks. Admission CSF revealed 58 cells (18 neutrophils and 17 lymphocytes), glucose 80 mg/100 mL, and protein 60 mg/100 mL. Serum virology shell vial assay for cytomegalovirus, varicella zoster, and herpes simplex, and viral tube culture were negative. Serum hemagglutinin inhibition for WNV antibodies (immunoglobulin [Ig] G and IgM) was negative on admission and days 7, 12, and 19 (titers <1:10 at the Ontario Ministry of Health Laboratory), becoming positive on day 36 with titers ≥1:2,560. Serum plaque reduction neutralization was also positive at 1:160 (Zoonotic Diseases and Special Pathogens Section, National Microbiologic Laboratory, Winnipeg, Canada). Noncontrast CT on day 4 was normal. MR examinations at 1.5 T on days 5 and 13 included T1- (pregadolinium and postgadolinium) and T2-weighted sequences, fluid-attenuated inversion recovery (FLAIR), and …
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