Abstract：
BACKGROUND: West Nile Virus is a single-stranded Ribonucleic Acid arbovirus of the Flaviviridae family that is transmitted to humans by Culex species mosquitoes. West Nile Virus infection is asymptomatic in the majority of affected people. Of those who develop symptoms, the usual manifestation is a febrile syndrome, while only 1% develop neurological symptoms due to a neuroinvasive form of infection, including encephalitis, meningitis, asymmetrical flaccid paralysis, or a combination of all these features. Parsonage-Turner syndrome is a rare disorder characterized by sudden painful symptoms and subsequent paralysis, involving a shoulder or one of the upper limbs due to post-infective brachial plexopathy. The etiology is unknown, although it can be considered a multifactorial process: a predisposing factor, such as viral infection or strenuous upper-extremity exercise, can trigger an immune-mediated process localized in the brachial plexus.
METHODS: In late summer, a 79-year-old male Italian patient was admitted to the emergency department for acute right upper limb weakness and high fever, without any mental status impairment, pain, sensory alterations, or signs of meningeal irritation. Laboratory tests confirmed acute West Nile Virus infection, expressed as a unilateral upper limb flaccid paralysis. After a few days, the patient reported an acute pain in the right upper limb scarcely responsive to nonsteroidal anti-inflammatory drug therapy and a subsequent wider distribution of flaccid paralysis. After multiple examinations, Parsonage-Turner syndrome could be suspected. Patient was treated with steroids and reported an improvement of clinical condition after 2 months, with complete pain remission but partial strength recovery in the affected limb.
CONCLUSIONS: West Nile Virus disease has a broad spectrum of neurological manifestations, among which the most common are signs of meningeal irritation or cognitive impairment. We report an unusual presentation of neuroinvasive West Nile Virus infection with arm weakness as expression of unilateral viral neuritis, followed by a post-infective brachial plexopathy consistent with Parsonage-Turner syndrome diagnosis. We diagnosed Parsonage-Turner syndrome after excluding the most common causes of atraumatic acute upper limb pain, through a challenging differential diagnosis in a patient with several comorbidities.
METHODS: In late summer, a 79-year-old male Italian patient was admitted to the emergency department for acute right upper limb weakness and high fever, without any mental status impairment, pain, sensory alterations, or signs of meningeal irritation. Laboratory tests confirmed acute West Nile Virus infection, expressed as a unilateral upper limb flaccid paralysis. After a few days, the patient reported an acute pain in the right upper limb scarcely responsive to nonsteroidal anti-inflammatory drug therapy and a subsequent wider distribution of flaccid paralysis. After multiple examinations, Parsonage-Turner syndrome could be suspected. Patient was treated with steroids and reported an improvement of clinical condition after 2 months, with complete pain remission but partial strength recovery in the affected limb.
CONCLUSIONS: West Nile Virus disease has a broad spectrum of neurological manifestations, among which the most common are signs of meningeal irritation or cognitive impairment. We report an unusual presentation of neuroinvasive West Nile Virus infection with arm weakness as expression of unilateral viral neuritis, followed by a post-infective brachial plexopathy consistent with Parsonage-Turner syndrome diagnosis. We diagnosed Parsonage-Turner syndrome after excluding the most common causes of atraumatic acute upper limb pain, through a challenging differential diagnosis in a patient with several comorbidities.
摘要：
背景：西尼罗河病毒是黄病毒科的单链核糖核酸虫媒病毒，由库蚊蚊子传播给人类。西尼罗河病毒感染在大多数受影响的人群中是无症状的。在那些出现症状的人中，通常的表现是发热综合征，虽然只有1%的人由于神经侵袭性感染而出现神经症状，包括脑炎,脑膜炎,不对称弛缓性麻痹,或所有这些功能的组合。Parsonage-Turner综合征是一种罕见的疾病，其特征是突然的疼痛症状和随后的瘫痪，由于感染后臂丛神经病变而累及肩膀或上肢之一。病因不明,虽然它可以被认为是一个多因素的过程：一个诱发因素，如病毒感染或剧烈的上肢运动，可以触发定位在臂丛中的免疫介导过程。
方法：夏末，一名79岁的意大利男性患者因急性右上肢无力和高烧进入急诊科，没有任何精神状态障碍，疼痛,感官改变，或脑膜刺激的迹象。实验室检查证实急性西尼罗河病毒感染,表示为单侧上肢弛缓性麻痹。几天后,患者报告右上肢急性疼痛对非甾体类抗炎药治疗几乎没有反应,随后出现广泛分布的弛缓性麻痹.经过多次检查,可能怀疑Parsonage-Turner综合征。患者接受类固醇治疗，2个月后报告临床状况有所改善，疼痛完全缓解，但患肢部分力量恢复。
结论：西尼罗河病毒病具有广泛的神经系统表现，其中最常见的是脑膜刺激或认知障碍的迹象。我们报告了神经侵袭性西尼罗河病毒感染的异常表现，伴有手臂无力，表现为单侧病毒性神经炎，随后是与Parsonage-Turner综合征诊断一致的感染后臂丛神经病变。我们在排除非创伤性急性上肢疼痛的最常见原因后诊断为Parsonage-Turner综合征，通过对患有多种合并症的患者进行具有挑战性的鉴别诊断。
方法：夏末，
结论：西尼罗河病毒病具有广泛的神经系统表现，
