ABSTRACT There are presently no in-depth published neuropsychological studies of West Nile Virus (WNV) encephalitis patients that have been well-correlated with high resolution structural MRI. In this study a middleaged male who developed West Nile Virus encephalitis five years previously was examined three times over a two year period. We examined him with the Wechsler Adult Intelligence Scales—Fourth Edition and the Wechsler Memory Scale—Fourth Edition (WAIS-IV/WMS-IV) and Advanced Clinical Solutions battery supplemented by tests of attention, executive, motor and sensory functions. Neuroradiological imaging revealed hypodensities within the left hippocampus in the axial and coronal planes with T2-FLAIR MRI. The man was previously high functioning and although he had prior history of well-controlled epilepsy it seems unlikely that the epilepsy could fully account for the neuropathological changes. The patient had previously completed a demanding six year double science degree program before he became ill with WNV and he had been a successful manager and director of a research company. Delayed auditory memory scores were at least two standard deviation units below age expected levels and semantic fluency and Booklet Category Tests of executive function were also in the impaired range. Moreover the illness onset profile of muscle weakness, extreme fatigue, memory complaints as well as inability to carry out research projects involving planning on the job were highly consistent with WNV encephalitis. If the memory and executive function deficits had been premorbid manifestations of epilepsy it is unlikely he would have attained the levels he did educationally and occupationally. This left hippocampal lesion is characteristic of other encephalitic viral infections such as herpes simplex virus. To our knowledge this is the first lateralized WNV encephalitis medial temporal lobe patient in the published literature.
Cite this paper
Gagnon, M. , Robinson, T. , Ijaz, M. and McCrea, S. (2012) Persistent delayed auditory memory and executive function deficits 5 years after West Nile Virus Encephalitis: A neuropsychological and neuroimaging single case study. World Journal of Neuroscience, 2, 210-216. doi: 10.4236/wjns.2012.24032.
 Sejvar, J.J., Curns, A.T., Welburg, L., Jones, J.F., Lundgren, L.M., Capuron, L., Pape, J., Reeves, W.C. and Campbell, G.L. (2008) Neurocognitive and functional outcomes in persons recovering from West Nile Virus illness. Journal of Neuropsychology, 2, 477-499.
 Sampson, B.A. and Armbrustmacher, V. (2001) West Nile Virus encephalitis: The neuropathology of four fatalities. Annals of the New York Academy of Sciences, 951, 172-178. Hdoi:10.1111/j.1749-6632.2001.tb02695.x
 Sahakian, B.J. and Owen, A.M. (1992) Computerized assessment in neuropsychiatry using CANTAB: Discussion paper. Journal of the Royal Society of Medicine, 85, 399-402.
 Owen, A.M., James, M., Leigh, P.N., Summers, B.A., Marsden, C.D., Quinn, N.P., Lange, K.W. and Robbins, T.W. (1992) Fronto-striatal cognitive deficits at different stages of Parkinson’s disease. Brain, 115, 1727-1751.
 Sadek, J.R., Pergam, S.A., Harrington, J.A., Echevarria, L.A., Davis, L.E., Goade, D., Harnar, J., Nofchissey, R.A., Sewell, C.M., Ettstad, P. and Haaland, K.Y. (2010) Persistent neuropsychological impairment associated with West Nile Virus infection. Journal of Clinical and Experiental Neuropsychology, 32, 81-87.
 Wilkinson, G. (1993) Wide range achievement test 3. Psychological Assessment Resources, Wilmington.
 Heaton, R.K., Miller, W., Taylor, M.J. and Grant, I. (2007) Revised comprehensive norms for an expanded halsteadreitan battery. Psychological Assessment Resources, Wilmington.
 Smith, A. (1973) Symbol digit modalities test. Western Psychological Services, Los Angeles.
 Brandt, J. and Benedict, R.H. (2001) Hopkins verbal learning test—Revised. Psychological Assessment Resources, Odessa.
 Wechsler, D. (1997) Wechsler memory scale. 3rd Edition, The Psychological Corporation, San Antonio.
 Meyers, J.E. and Meyers, K. (1995) Rey complex figure test and recognition trial: Professional manual. Psychological Assessment Resources, Odessa.
 Kelley, T.W., Prayson, R.A., Ruiz, A.I., Isada, C.M. and Gordon, S.M. (2003). The neuropathology of West Nie Virus meningoencephalitis: A report of two cases and a review of the literature. American Journal of Clinical Pathology, 119, 749-753.
 NCS Pearson (2009) Advanced clinical solutions for WAIS-IV and WMS-IV: Administration and scoring manual. Psychological Corporation, San Antonio.
 Lezak, M.D., Howieson, D.B. and Loring, D.W. (2004) Neuropsychological assessment. 4th Edition, Oxford University Press, New York.
 Delis, D., Kaplan, E., Kramer, J. and Ober, B. (2000) Ca- lifornia verbal learning Test–II. The Psychological Corporation, San Antonio.
 Benedict, R.H.B. (1997) Brief visuospatial memory test —Revised: Professional manual. Psychological Assessment Resources, Odessa.
 Heaton, R.K., Chelune, G.J., Talley, J.L., Kay, G.G. and Curtiss, G. (1993) Wisconsin card sorting test manual: Revised and expanded. Psychological Assessment Resources, Odessa.
 Defilippis, N., and McCambell, E. (1991) The booklet category test. Psychological Assessment Resources, Odessa.
 Wechsler, D. (2008) Wechsler adult intelligence scale, 4th Edition, The Psychological Corporation, San Antonio.
 Doty, R.L. (1995) The smell identification test administration manual. 3rd Edition, Sensonics, Haddon Heights.
 Morey, L.C. (1991) The personality assessment inventory professional manual. Psychological Assessment Resources, Odessa.
 Tellegen, A. And Ben-Porath, Y.S. (2008) MMPI-2-RF technical manual. University of Minnesota Press, Minneapolis.
 Beck, A.T., Steer, R.A. and Brown, G.K. (1996) Manual for the beck depression inventory-II. The Psychological Corporation, San Antonio.
 Beck, A.T. and Steer, R.A. (1990) Manual for the beck anxiety inventory. The Psychological Corporation, San Antonio.
 Beck, A.T. and Steer, R.A. (1993) Manual for the beck hopelessness scale. The Psychological Corporation, San Antonio.
 Kapur, N., Barker, S., Burrows, E.H., Ellison, D., Brice, J., Illis, L.S., Scholey, K., Colbourn, C., Wilson, B. and Loates, M. (1994) Herpes simplex encephalitis: Longterm magnetic resonance imaging and neuropsychological profile. Journal of Neurology, Neurosurgery, and Psychiatry, 57, 1334-1342. Hdoi:10.1136/jnnp.57.11.1334
 Ropper, A.H. and Samuels, M.A. (2009) Principles of neurology. 9th Edition, McGraw-Hill Medical, New York.