Objective:

Our objective is to showcase the possibility of West Nile Virus causing an atypical presentation of cauda equina syndrome

Background:

63M presents with 6 days of ongoing saddle anesthesia, urinary retention and bilateral feet paresthesia. Symptoms came on acutely without traumatic onset. He started developing balance difficulties leading him to seek further medical management.

Design/Methods:

We performed a MRI Brain + T and L spine WWO. He had 2 lumbar punctures. Meningitis/Encephalitis panel was sent along with CSF culture including gram stain/fungal/acid fast bacilli

Results:

He had a MRI Brain, T/L spine WWO showing enhancement and mild thickening of the ventral cauda equina nerve roots. Two lumbar punctures were performed showing mild lymphocytic pleocytosis (13) with increment (27) on the subsequent lumbar puncture. Protein was elevated as well (128/176). There were no central cord enhancement concerning for transverse myelitis. His CSF West Nile IgM came back positive (2.58).

Conclusions:

We had a 63M presenting cauda equina syndrome due to non-traumatic etiology. After extensive workup with spinal imaging and CSF analysis, it was proved to be due to West Nile Virus from CSF and serum IgM confirmation. It is an interesting case presentation where West Nile Virus did not cause the typical cord syndrome or motor neuron disease, but rather cauda equina involvement.