Expanding the spectrum of oropouche virus neurological disease: emerging evidence from the 2025 Panama outbreak.

Oropouche virus is an emerging arbovirus whose neurotropic potential is increasingly recognized across the Americas. During the 2024-2025 outbreak in Panama, we identified six patients with confirmed or probable infection who developed a broad range of neurological manifestations. Neurological symptoms arose several days after the onset of systemic illness and included ocular motor disturbances such as nystagmus and opsoclonus, cerebellar signs including ataxia and vertigo, seizures, altered mental status, and meningeal irritation. Cerebrospinal fluid analyses frequently demonstrated mononuclear pleocytosis, while neuroimaging was largely unremarkable. Viral RNA was consistently undetectable in cerebrospinal fluid but was identified in urine beyond the acute phase, extending the diagnostic window in patients with delayed presentation. Most individuals recovered with supportive care; however, one patient died following refractory status epilepticus, and another required prolonged intensive care. This case series represents the first report of neurologically symptomatic Oropouche virus infections in Panama and expands the recognized neurological spectrum of the disease. These findings underscore the importance of maintaining clinical suspicion for neuroinvasive presentations, incorporating alternative diagnostic specimens, and strengthening surveillance efforts as Oropouche virus continues to emerge regionally.