Bilateral diaphragmatic paralysis and related respiratory complications in a patient with West Nile virus infection

Betensley, Alan D.; Jaffery, S H; Collins, Howard D.; Sripathi, Naganand; Alabi, Fortune O.

doi:10.1136/thorax.2003.009092

Cited by 28 publications

(19 citation statements)

References 4 publications

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“…This is consistent with human clinical studies and case reports documenting WNV disease signs such as respiratory distress [29], diaphragmatic paralysis [2], gastrointestinal involvement, urinary retention [31], bladder dysfunction [29], fatigue [19], and cardiac arrhythmia [4]. West Nile virus infection is fatal in <1 % of human cases [20], but the fatality rate in experimentally infected mice and hamsters is typically reported to be between 20 and 80 % [23, 28, 35].…”

Section: Introductionsupporting

confidence: 91%

Autonomic deficit not the cause of death in West Nile virus neurological disease

et al. 2013

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IntroductionSome West Nile virus (WNV)-infected patients have been reported to manifest disease signs consistent with autonomic dysfunction. Moreover, WNV infection in hamsters causes reduced electromyography amplitudes of the gastrointestinal tract and diaphragm, and they have reduced heart rate variability (HRV), a read-out for the parasympathetic autonomic function.MethodsHRV was measured in both hamsters and mice using radiotelemetry to identify autonomic deficits. To identify areas of WNV infection within the medulla oblongata mapping to the dorsal motor nucleus of vagus (DMNV) and the nucleus ambiguus (NA), fluorogold dye was injected into the cervical trunk of the vagus nerve of hamsters. As a measurement of the loss of parasympathetic function, tachycardia was monitored contiguously over the time course of the disease.ResultsDecrease of HRV did not occur in all animals that died, which is not consistent with autonomic function being the mechanism of death. Fluorogold-stained cells in the DMNV were not stained for WNV envelope protein. Fourteen percent of WNV-stained cells were co-localized with fluorogold-stained cells in the NA. These data, however, did not suggest a fatal loss of autonomic functions because tachycardia was not observed in WNV-infected hamsters.ConclusionParasympathetic autonomic function deficit was not a likely mechanism of death in WNV-infected rodents and possibly in human patients with fatal WN neurological disease.

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Section: Introductionsupporting

confidence: 91%

Autonomic deficit not the cause of death in West Nile virus neurological disease

et al. 2013

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“…The most widely recognized WNV-induced disease sign controlled by autonomic function is respiratory distress (Betensley et al, 2004; Sejvar et al, 2005), which can result in respiratory failure with a poor prognosis (Sejvar et al., 2006). WNV-induced respiratory distress mechanisms have been extensively studied in rodents and are discussed below.…”

Section: Introductionmentioning

confidence: 99%

Neurological approaches for investigating West Nile virus disease and its treatment in rodents

2013

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West Nile virus (WNV) has had a major public health impact since its emergence in the Western Hemisphere; in 2012, nearly 3000 cases of WN neuroinvasive disease were identified in the United States. The underlying mechanisms of WN neurologic disease can only be studied to a limited extent in patients, but can be investigated in much greater detail in animal models. In this paper, we describe how we and others have employed a variety of electrophysiological and neurological techniques to study experimental WNV infections in hamsters and mice. The methods have included electrophysiological motor unit number estimation; optogenetic photoactivation of the spinal cord and electromyography; plethysmography; measurement of heart rate variability as an indication of autonomic nervous system dysfunction; and an assessment of spatial memory loss using the Morris water maze. These techniques provide a more refined assessment of disease manifestations in rodents than traditional measurements of weight loss and mortality, and should make it possible to identify targets for therapeutic intervention and to directly assess the effects of novel treatments.

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“…8,13 Additionally, up to 20% of patients have a paralyzed diaphragm after cardiothoracic surgery. 13,14 Other less common causes of phrenic nerve paralysis include direct invasion by neck and mediastinal malignancies, extrinsic compression by an aortic aneurysm, infectious, inflammatory, metabolic neuropathies, and central nervous system pathology including cerebrovascular accidents and spinal cord tumor [15][16][17][18] (Fig 7). Paralysis can be unilateral or bilateral.…”

Section: Phrenic Nerve Paralysismentioning

confidence: 99%

Diaphragm Appearance: A Clue to the Diagnosis of Pulmonary and Extrapulmonary Pathology

Abbey-Mensah

Waite

Reede

et al. 2017

Current Problems in Diagnostic Radiology

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Bilateral diaphragmatic paralysis and related respiratory complications in a patient with West Nile virus infection

Cited by 28 publications

References 4 publications

Autonomic deficit not the cause of death in West Nile virus neurological disease

Autonomic deficit not the cause of death in West Nile virus neurological disease

Neurological approaches for investigating West Nile virus disease and its treatment in rodents

Diaphragm Appearance: A Clue to the Diagnosis of Pulmonary and Extrapulmonary Pathology

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