Q: Which meningitis may present with asymmetric flaccid paralysis during mosquito season in summer to early fall?


Answer: West Nile (WN)

WN virus infection may present as an acute asymmetric weakness of the limbs or flaccid paralysis. Paralysis results from an anterior horn cell process. To make diagnosis difficult, symptoms may occur with or without signs of meningitis or encephalitis.



References:

1. Sejvar JJ, Bode AV, Marfin AA, et al. West Nile virus-associated flaccid paralysis. Emerg Infect Dis 2005; 11:1021. 

2. Li J, Loeb JA, Shy ME, et al. Asymmetric flaccid paralysis: a neuromuscular presentation of West Nile virus infection. Ann Neurol 2003; 53:703. 

3. Jeha LE, Sila CA, Lederman RJ, et al. West Nile virus infection: a new acute paralytic illness. Neurology 2003; 61:55.