Non-convulsive status epilepticus in West Nile Virus Meningoencephalitis: two cases and review of literature

Background: West Nile Virus (WNV) is an arthropod-borne flavivirus which causes epidemic spread by mosquito bites and its incidence has been ever increasing. Though less than 1% of infections lead to severe neurological involvement, meningoencephalitis is the major cause of morbidity and mortality. There has been little data on the presentation of seizures or non-convulsive status in WNV. We aim to highlight (1) the presentation of nonconvulsive status in WNV infection and (2) value of electroclinical monitoring in its management. Methods: Literature research was conducted using Medline/Pubmed for identifying presenting symptoms in WNV encephalitis. Common and uncommon presentations are described. We report two cases of WNV encephalitis with status epilepticus and review electroencephalographic changes and discuss complexities in its management. Pertinent literature on the investigative findings, management and the outcomes is presented. Results: Electroclinical monitoring revealed patterns consistent with non convulsive status. Antiepileptic medications effectively aborted seizures resulting in clinical improvement. Both patients recovered with minimal neurological impairment and were discharged to rehabilitation facilities. Conclusions: Neurological complications in the form of seizures due to WNV may be more common than realized. Clinicians should have a high index of clinical suspicion for nonconvulsive status when dealing with WNV infected patients presenting with altered sensorium. Continuous electroencephalographic monitoring is crucial in their management.

Abstract licence: CC BY

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