Recovery and prognosticators of paralysis in West Nile virus infection
Recovery and prognosticators of paralysis in West Nile virus infection
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DOI：
10.1016/j.jns.2005.05.007
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发表时间：
2005-09-15
影响因子：
4.4
通讯作者：
Li, J
中科院分区：
文献类型：
--
作者：
Cao, NJY;Ranganathan, C;Li, J
以往的研究表明，前角运动神经元的病变是由于西尼罗河病毒（WNV）感染瘫痪患者的主要病理。为了表征恢复和确定瘫痪恢复的预后因素，我们对11例患者进行了电生理检查和肌肉活检，1例进行了尸检。我们发现四肢无力是明显不对称的，并且在上肢和下肢之间存在差异，这表明脊髓前角局灶性或节段性受累。尸检时脊髓运动神经元的节段性耗竭支持了这一点。在21个月的随访期内，临床恢复情况各不相同。为了解释变异性，我们对6例患者进行了运动单位数估计（MUNE）。在测试肌肉中，MUNE值和强度相关。我们还在肌肉活检中发现了运动神经末梢损伤，这表明了另一种可能的机制，即短暂的虚弱和可变的恢复。我们的结论是，病理病变的类型可能会有所不同，在麻痹性西尼罗河病毒感染，不同程度或运动神经元的损失和运动神经末梢的变化组合可能会占所观察到的程度的弱点和恢复。(c)2005 Elsevier B.V.保留所有权利。
Previous studies have demonstrated that lesions of the anterior horn motor neurons are the primary pathology in patients with paralysis due to West Nile virus (WNV) infection. To characterize recovery and identify prognostic factors for the recovery of paralysis, we investigated 11 patients with electrophysiology testing and muscle biopsy, and one with autopsy. We found that limb weakness was markedly asymmetric and differed between upper and lower extremities, suggesting focal or segmental involvement of the spinal cord anterior horn. This was supported by segmental depletion of spinal motor neurons at autopsy. Clinical recovery was variable during a 21-month follow-up period. To explain variability, we performed motor unit number estimation (MUNE) in six patients. MUNE values and strength were correlated in tested muscles. We also detected motor nerve terminal damages in muscle biopsies, suggesting another possible mechanism for transient weakness and variable recovery. We conclude that the type of pathological lesions may vary in paralytic WNV infection, and different degrees or combinations of motor neuron loss and motor nerve terminal changes may account for the observed degrees of weakness and recovery. (c) 2005 Elsevier B.V. All rights reserved.