Neurological Illness Cluster in Colorado May Be Related to EV-D68

the Neurology Advisor take:

The CDC and Colorado Department of Public Health and Environment have asked physicians to report occurrences of limb weakness and spinal cord lesions in persons under 21 years after a cluster of nine children presented with an acute neurological illness.

The alert comes as Enterovirus-D68 continues to spread across the United States, with over 500 confirmed cases of the respiratory illness. Up to four deaths may be linked to the virus.

Nine children being evaluated at Children’s Hospital Colorado presented with extremity weakness, cranial nerve dysfunction or both, and nearly all had symptoms of an upper respiratory illness prior to the onset of neurological illness. Spinal cord lesions were detected in seven of eight patients using MRI, and seven of nine patients had brainstem lesions.

Testing of cerebrospinal fluid (CSF) showed no evidence of West Nile Virus or enteroviruses, including EV-D68. However, nasopharyngeal specimens from six patients tested positive for rhinovirus/enterovirus, four of which were identified as EV-D68.

Two previous cases of EV-D68 reported neurologic illness, including acute paralysis and encephalomyelitis, with detection of EV-D68 in the CSF. However, given the circulation of EV-D68 in Colorado and elsewhere, patients with neurological illness and positive detection of EV-D68 may be coincidental. Further investigation of lab results and epidemiology are ongoing.