Severe West Nile Virus Neuroinvasive Disease: Clinical Characteristics, Short- and Long-Term Outcomes.

West Nile Virus Neuroinvasive Disease (WNV NID) requires prolonged intensive care treatment, resulting in high mortality and early disability. Long-term results are lacking. We have conducted an observational retrospective study with a prospective follow-up of WNV NID patients treated at the Intensive Care Unit (ICU), University Hospital for Infectious Diseases, Zagreb, Croatia, 2013-2018. Short-term outcomes were vital status, length of stay (LOS), modified Rankin Scale (mRS), and disposition at discharge. Long-term outcomes were vital status and mRS at follow-up. Twenty-three patients were identified, 78.3% males, median age 72 (range 33-84) years. Two patients (8.7%) died in the ICU, with no lethal outcomes after ICU discharge. The median ICU LOS was 19 days (range 5-73), and the median hospital LOS was 34 days (range 7-97). At discharge, 15 (65.2%) patients had moderate to severe/mRS 3-5, 6 (26.0%) had slight disability/mRS 2-1, no patients were symptom-free/mRS 0. Ten (47.6%) survivors were discharged to rehabilitation facilities. The median time to follow-up was nine months (range 6-69). At follow-up, seven patients died (30.5%), five (21.7%) had moderate to severe/mRS 3-5, one (4.3%) had slight disability/mRS 2-1, six (26.1%) had no symptoms/mRS 0, and four (17.4%) were lost to follow-up. Briefly, ten (43.5%) survivors improved their functional status, one (4.3%) was unaltered, and one (4.3%) aggravated. In patients with severe WNV NID, intensive treatment in the acute phase followed by inpatient rehabilitation resulted in significant recovery of functional status after several months.

Cauda equina arachnoiditis - a rare manifestation of West Nile virus neuroinvasive disease: A case report.

BACKGROUND: Data regarding the neuroradiology features of the West Nile virus neuroinvasive disease (WNV NID) is rather scarce. To contribute to the knowledge of the WNV NID, we present a patient with a combination of encephalitis and acute flaccid paresis, with cauda equina arachnoiditis as the main magnetic resonance (MR) finding. CASE SUMMARY: A 72-year-old female patient was admitted due to fever, headache and gait instability. During the first several days she developed somnolence, aphasia, urinary incontinence, constipation, and asymmetric lower extremities weakness. Cerebrospinal fluid analysis indicated encephalitis. Native brain computed tomography and MR were unremarkable, while spinal MR demonstrated cauda equina enhancement without cord lesions. Virology testing revealed WNV IgM and IgG antibodies in serum and cerebrospinal fluid, which confirmed acute WNV NID. The treatment was supportive. After two months only a slight improvement was noticed but cognitive impairment, loss of sphincter control and asymmetric inferior extremities weakness remained. The patient died after a month on chronic rehabilitation. CONCLUSION: Cauda equina arachnoiditis is a rare, but possible neuroradiological feature in acute flaccid paresis form of WNV NID.

Factors Determining Scientific Paper Productivity by Neuroradiology Fellows.

RATIONALE AND OBJECTIVES: We sought to determine (1) whether United States Medical Licensing Examination (USMLE) scores predict academic productivity in neuroradiology fellows as measured by publications and citations, and (2) what factors predict such productivity. MATERIALS AND METHODS: We reviewed the USMLE scores, gender, medical school location attended, publication record before and during fellowship, fellowship evaluation ratings and subsequent practice site (private vs academic) of neuroradiology fellows from 2004 to 2014 to determine relationships with publications and citations after fellowship. Spearman's correlation and Poisson regression analyses were performed to assess the association between these factors and quantity of publications and citations per year after fellowship. RESULTS: USMLE scores and fellowship evaluation scores correlated inversely with radiology publications and citations. There were strong correlations between publication records before or during fellowship and after fellowship. Fellows from international medical schools, with PhD degrees, and those fellows proceeding to academic practice had more publications before or during and after neuroradiology fellowship. CONCLUSIONS: The best predictors of whether a graduating neuroradiology fellow will publish and have high citation rates is prior publication record, a PhD degree, and staying in academics. USMLE scores and evaluations during the fellowship were inversely correlated with publication measures of academic productivity.