Noradrenaline in Artery Walls and its Dispersal by Reserpine

Objective: N/A. Background: West Nile virus (WNV) first emerged in the late 1990s in the United States. Since then upwards of 23,000 cases have been reported. Presentation of WNV varies from West Nile fever in approximately 20% of patients to West Nile neuroinvasive disease in less than 1% of infected individuals. Here we present a patient with neuroinvasive West Nile encephalitis who presented with Anton-Babinski syndrome (ABS). Design/Methods: A 55-year-old female with a past medical history of hypertension, hypothyroidism, hyperlipidemia and CKD presented to a community hospital in the Summer with sudden acute onset of fevers, chills, and altered mental status. Vital signs were significant for a fever of 39.0 C, and blood pressure 180/112. Laboratory results were significant for elevated white blood cell count of 22,000/ul. Neurologic exam was significant for altered mental status (oriented only to self). MRI brain revealed T2/FLAIR hyperintensities in the fontal, temporal, and occipital cortices. A lumbar puncture was completed with concern for autoimmune encephalitis which had returned negative. A preliminary diagnosis of posterior-reversible encephalopathy syndrome (PRES) was made. After 8 weeks with no significant improvement the patient was transferred to a tertiary care center. Physical exam was notable for no response to visual threat, equal and reactive pupils, and visual anosognosia with confabulations. A repeat MRI showed interval progression of the previously defined lesions. A repeat LP with clear CSF was obtained and serum blood test revealed an elevated WNV IgG, CSF and serum of 1.89 and 2.62 respectively. Based on clinical progression and prognosis of WNV the patient was referred to a long term care facility. Results: N/A. Conclusions: Neuroinvasive West Nile disease remains to be a rare diagnosis and it’s radiographic and clinical presentation vary. This case aims to highlight the importance of early diagnosis and recognition of symptoms to improve clinical outcomes. Disclosure: Dr. Srichawla has nothing to disclose. Dr. Min has nothing to disclose.