Kimberly Hutchinson, Student, School of Psychology; Lawrence Dilks, Clinical Neuropsychologist, Counseling Services of SWLA; Thomas DuVall, Student, School of Psychology; Burton Ashworth, Student, School of Psychology; Lisa Hubbard, Student, School of Psychology; Jacqueline Bourassa, Student, McNeese State University
Relatively recently, West Nile Virus (WNV) has reached the point of seasonal outbreaks in the United States. Most cases of WNV are asymptomatic. Approximately 20% of patients will develop West Nile fever, a flu-like illness that is a self-limited, benign condition. However, approximately one percent of patients will develop a neuroinvasive form of the disease resulting in meningitis, encephalitis, or acute flaccid paralysis (Carson et al., 2006). Risk factors for developing the most severe form of the disease include: compromised immune system due to medications (e.g., posttransplant) or other illnesses, older age, and male gender (Arciniegas & Anderson, 2004). To date, little neuropsychological data is available. This purpose of this case study is to examine the neuropsychological sequelae of West Nile encephalopathy.
“AZ,” is a 52-year-old married woman with 12 years of education who was working as an administrative assistant when she contracted WNV. Following an extended hospital stay of three months, which included time on the intensive care unit and an extended care unit, she was seen for neuropsychiatric evaluation in an inpatient medical rehabilitation unit. Medical history was positive for epilepsy and eight separate treatments for cervical cancer with full recovery. Treatment for anal cancer was interrupted by the WNV encephalopathy and was scheduled to resume post discharge. The client also reported a history of mild depression that is well controlled with medication.
AZ completed a neuropsychological battery that included: intelligence testing, measures of executive function, memory, language, adaptive behavior, motor function, perceptual-motor skills, and mood inventories. Testing was administered in multiple sessions due to fatigue and to accommodate her treatment regimen. There were no unusual occurrences during the procedure to limit the validity of the evaluation.
Her performance demonstrated impairments in verbal comprehension and processing speed, planning and problem solving, memory, language, and motor function. Adaptive behavior was in the very limited range. Depression was mild and anxiety was significant. Her performance was suggestive of Cognitive Disorder, NOS secondary to Epilepsy and sequelae of West Nile Meningioencephalitis. AZ falls into the one percent of individuals who experience a neuroinvasive form of the disease. Her complex medical history provides support for the risk factors proposed by Arciniegas and Anderson (2004). A follow-up evaluation in six months to one year would be valuable to monitor continued improvements or deterioration in functioning. While this case study contributes to accumulating knowledge of the sequelae of WNV, further study and additional data are needed to understand how neuropsychiatric functioning is impacted long term.