[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-453723-105":59,"doc-detail-453723-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","neuroinvasive-west-nile-virus-presenting-as-subacute-progressive-quadriparesis-and-intractable-pain-a-case-report","Neuroinvasive West Nile Virus Presenting as Subacute Progressive Quadriparesis and Intractable Pain - A Case Report","","Neuroinvasive West Nile virus can present with severe neurologic morbidity and mortality despite most infections remaining asymptomatic. This case report describes a 57-year-old man from rural Wisconsin with a 10-week course of progressive asymmetric quadriparesis and intractable pain, preceded by fatigue, shoulder pain, and paresthesias. Examination revealed mild encephalopathy, bulbar involvement, and mixed upper and lower motor neuron signs. MRI and electrodiagnostic testing initially suggested amyotrophic lateral sclerosis; elevated WNV IgM/IgG confirmed neuroinvasive WNV. Despite corticosteroids and intravenous immunoglobulin, the patient deteriorated and transitioned to hospice care, with autopsy showing T-cell–mediated meningoencephalitis and diffuse axonopathy.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/neuroinvasive-west-nile-virus-presenting-as-subacute-progressive-quadriparesis-and-intractable-pain-a-case-report/453723/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/neuroinvasive-west-nile-virus-presenting-as-subacute-progressive-quadriparesis-and-intractable-pain-a-case-report/453723.png","ImageObject",300,407,{"name":92,"@type":93},"Genevieve","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How did the patient’s symptoms progress before diagnosis?","Question",{"text":112,"@type":113},"A 57-year-old man developed a 10-week history of progressive asymmetric quadriparesis and severe diffuse pain. Symptoms began in late fall with fatigue and right shoulder pain, then progressed with worsening myalgias and paresthesias, culminating in significant weakness of all four extremities.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What initial diagnosis did clinicians consider based on testing?",{"text":117,"@type":113},"Electrodiagnostic studies showed diffuse active denervation with reduced compound muscle action potentials, initially raising concern for amyotrophic lateral sclerosis.",{"name":119,"@type":110,"acceptedAnswer":120},"How was neuroinvasive West Nile virus confirmed despite early concern for motor neuron disease?",{"text":121,"@type":113},"Elevated WNV IgM and IgG titers were detected in serum and cerebrospinal fluid, confirming neuroinvasive WNV infection.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},453723,1791093780,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},1374391974585,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Wiley  \nCase Reports in Neurological Medicine Volume 2026, Article ID 5565739, 6 pages [https://doi.org/10.1155/crnm/5565739](https://doi.org/10.1155/crnm/5565739)  \nCase Report  \nNeuroinvasive West Nile Virus Presenting as Subacute Progressive Quadriparesis and Intractable Pain: A Case Report  \nMick B. Reedy, 1 Mohammad Abdul Azeem , 1 Thanujaa Subramaniam, 1  \nShahriar Salamat,2,3 Howard Rowley,4 and Bradley Beinlich 1  \n1 Department of Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA  \n2 Department of Pathology, University of Wisconsin-Madison, Madison, Wisconsin, USA  \n3 Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA  \n4 Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA  \nCorrespondence should be addressed to Bradley Beinlich; [beinlich@neurology.wisc.edu](beinlich@neurology.wisc.edu)  \nReceived 14 May 2024; Revised 28 November 2025; Accepted 16 December 2025  \nAcademic Editor: Semonti Nandi  \nCopyright © 2026 Mick B. Reedyet al. Case Reports in Neurological Medicine published by John Wiley & Sons Ltd. Tis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nWest Nile virus (WNV) is the most common mosquito-borne infection in North America; while most cases are asymptomatic, fewer than 1% develop neuroinvasive disease with signifcant morbidity and mortality. We report a 57-year-old man from rural Wisconsin who presented with a 10-week history of progressive asymmetric quadriparesis and severe intractable pain, preceded by fatigue, shoulder pain, and paresthesias. Neurologic examination demonstrated mild encephalopathy, bulbar involvement, and mixed upper and lower motor neuron signs. MRI showed patchy thoracic cord T2 hyperintensities and difuse lumbar ventral root enhancement. Electrodiagnostic studies revealed difuse active denervation and reduced compound muscle action potentials, initially raising concern for amyotrophic lateral sclerosis. Elevated WNV IgM and IgG titers in serum and cerebrospinal fuid confrmed neuroinvasive WNV infection. Despite treatment with corticosteroids and intravenous immunoglobulin, the patient deteriorated and was transitioned to hospice care. Autopsy demonstrated T-cell–mediated meningoencephalitis with widespread lymphocytic infammation involving motor neurons, spinal cord, ventral rootlets, and peripheral nerves, consistent with difuse axonopathy. Tis case underscores that neuroinvasive WNV may closely mimic motor neuron disease and emphasizes the importance ofserologic testing for accurate diagnosis. Management remains supportive, and outcomes can be severe due to extensive central and peripheral nervous system involvement.  \nKeywords: autopsy; case report; neuroinfectious disease; neuroinvasive West Nile virus; neuromuscular  \n1. Introduction  \nWest Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the United States [1] . Recent national surveillance data demonstrate that WNV accounted for 2628 of the 2770 reported arboviral disease cases in 2023, reafrming its continued predominance among mosquitoborne pathogens [2] . Long-term surveillance from 1999 to 2024 confrms the sustained burden and geographic persistence of WNV across the United States [3] . Although transmission through blood products or organ transplantation is rare [4, 5], most infections result from  \nmosquito exposure and demonstrate marked seasonality, with case counts peaking between July and September [6] .  \nApproximately 25% of infected individuals develop symptomatic West Nile fever after an incubation period of 2–14 days and typically present with abrupt, nonspecifc symptoms including fever, rash, headache, malaise, myalgias, chills, and emesis [7, 8]. While most cases are mild and selflimited, fewer than 1% progress to neuroinvasive disease, ","cbCaiqdG16oVWn89","https://ap.wps.com/l/cbCaiqdG16oVWn89","pdf",2108433,"English","# Introduction\n## Neuroinvasive spectrum and clinical presentations\n# Case Reports in Neurological Medicine\n## Encephalitis and acute flaccid paralysis patterns\n# Case Presentation\n## Symptom onset and progression\n## Hospital course and diagnostic findings","[{\"question\":\"How did the patient’s symptoms progress before diagnosis?\",\"answer\":\"A 57-year-old man developed a 10-week history of progressive asymmetric quadriparesis and severe diffuse pain. Symptoms began in late fall with fatigue and right shoulder pain, then progressed with worsening myalgias and paresthesias, culminating in significant weakness of all four extremities.\"},{\"question\":\"What initial diagnosis did clinicians consider based on testing?\",\"answer\":\"Electrodiagnostic studies showed diffuse active denervation with reduced compound muscle action potentials, initially raising concern for amyotrophic lateral sclerosis.\"},{\"question\":\"How was neuroinvasive West Nile virus confirmed despite early concern for motor neuron disease?\",\"answer\":\"Elevated WNV IgM and IgG titers were detected in serum and cerebrospinal fluid, confirming neuroinvasive WNV infection.\"}]","Neuroinvasive West Nile Virus Presenting as Subacute Progressive Quadriparesis and Intractable Pain - A Case Report | PDF",1790739452,15]