Dengue fever presenting as acute cerebellar ataxia: Case report and literature review

Holanda, Arthur Cesário de; Maranhão, Eduardo; Silva, Luísa van der Linden Ferreira da; Bezerra, Marcos Eugênio Ramalho; Melo, Eduardo Sousa de

doi:10.1007/s13365-022-01082-3

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…7 In cases where other serological and biochemical diagnostic tests remain inconclusive, the "double-doughnut" sign can assist clinicians' suspicion towards dengue encephalitis (like ours) and avoid lumbar puncture in cases where it may be risky. 7 Noticeably, in our case, the thalamic involvement was not symmetrical, and there was bilateral cerebellar involvement (a recognized but infrequent neuroimaging finding in dengue) [18][19][20] and no blooming artifact in the gradient echo sequence. In our case, signal hyperintensities in all sequences suggest late subacute bleeding (e.g., extracellular methemoglobin deposit).…”

Section: Discussionmentioning

confidence: 49%

An Intriguing Case of Expanded Dengue Syndrome With Co-existing Encephalitis, Pancreatitis, and Hepatitis: The Classic Thalamic “Double-Doughnut” Sign Revisited

Biswas,

León-Ruiz,

Ghosh

et al. 2024

The Neurohospitalist

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Background Dengue neuro-infection can present with symptoms ranging from mild to severe. Atypical presentations, such as expanded dengue syndrome, pose diagnostic and therapeutic challenges. Neuroimaging findings, particularly the “double-doughnut” sign on brain magnetic resonance imaging (MRI), have emerged as one of the most valuable aids in diagnosing complex cases of central nervous system infection by dengue virus. Case Presentation We report the case of a 35-year-old female from rural West Bengal, India, with expanded dengue syndrome. The patient presented with fever, headaches, body aches, and sudden disorientation over minutes, which progressed to a coma. Neurological examination revealed profound unconsciousness and nuchal rigidity. Laboratory findings were consistent with dengue infection, including altered liver and pancreatic enzyme levels. The diagnosis was facilitated by identifying the “double-doughnut” sign on the brain MRI, which suggested dengue encephalitis. This finding and clinical and serological evidence guided the treatment strategy. Discussion The “double-doughnut” sign, though not exclusive to dengue encephalitis, proved crucial in this case, aiding in differentiating from other causes of encephalitis. Recognition of this sign can be pivotal in diagnosing expanded dengue syndrome, facilitating timely and appropriate intervention, and improving patient outcomes. This case also underscores the importance of considering dengue in the differential diagnosis of encephalitis, especially in endemic areas. Also, this case’s excellent outcome (both clinically and radiologically) was noteworthy.

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Section: Discussionmentioning

confidence: 49%

An Intriguing Case of Expanded Dengue Syndrome With Co-existing Encephalitis, Pancreatitis, and Hepatitis: The Classic Thalamic “Double-Doughnut” Sign Revisited

Biswas,

León-Ruiz,

Ghosh

et al. 2024

The Neurohospitalist

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“…Cerebellar ataxia (CA) is a neurological condition characterized by a loss of coordination due to dysfunction in the cerebellum, a part of the brain that is responsible for the motor control 1 . Various underlying conditions can be involved in the development of CA, including stroke, tumors, exposure to toxins such as alcohol abuse, and infections with several different diseases like arboviral diseases and malaria 2,3 . It is important to note that Sudan is endemic with several infectious diseases that are involved in the development of CA, including COVID‐19, 4,5 arboviruses such as Chikungunya, 6 Crimean–Congo hemorrhagic fever (CCHF), 7 dengue, 2 Rift Valley fever, 8 West Nile virus, 9 Zika, 10 and Yellow fever 11 as well as emerging infectious diseases like schistosomiasis, TB, and different fungal infection 12 .…”

Section: Introductionmentioning

confidence: 99%

“… 1 Various underlying conditions can be involved in the development of CA, including stroke, tumors, exposure to toxins such as alcohol abuse, and infections with several different diseases like arboviral diseases and malaria. 2 , 3 It is important to note that Sudan is endemic with several infectious diseases that are involved in the development of CA, including COVID‐19, 4 , 5 arboviruses such as Chikungunya, 6 Crimean–Congo hemorrhagic fever (CCHF), 7 dengue, 2 Rift Valley fever, 8 West Nile virus, 9 Zika, 10 and Yellow fever 11 as well as emerging infectious diseases like schistosomiasis, TB, and different fungal infection. 12 Furthermore, malaria is hyperendemic in Sudan 13 and in addition to it is major role in the development of CA, it involves in several other neurological disorders.…”

Section: Introductionmentioning

confidence: 99%

Delayed cerebellar ataxia induced by Plasmodium falciparum malaria: A rare complication

Siddig,

Misbah El‐Sadig,

Eltigani

et al. 2023

Clinical Case Reports

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Key Clinical MessageIn endemic areas, malaria‐induced cerebellar ataxia should be suspected in patients presenting with neurological disorders including slurred speech, tremors, and a sense of imbalance and dizziness while walking. Healthcare providers should be aware to properly investigate and early detect and manage infections associated with the development of cerebellar ataxia to improve the case management and clinical outcome cost‐effectively.AbstractHere, we report the clinical manifestations, investigations, and outcomes of a patient developed delayed cerebellar ataxia following a malaria infection: an unusual complication of the disease. This report highlights the diagnostic challenges in a country endemic with several infectious diseases, yet it has a limited diagnostic and surveillance capacity.

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Dengue virus infection and neurological manifestations: an update

Fong,

Wong,

Tan

2023

Brain

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Dengue virus is a flavivirus transmitted by the mosquitoes, Aedes aegypti and Aedes albopictus. Dengue infection by all four serotypes (DEN 1 to 4) is endemic globally in regions with tropical and sub-tropical climates, with an estimated 100-400 million infections annually. Among those hospitalized, the mortality is about 1%. Neurological involvement has been reported to be about 5%. The spectrum of neurological manifestations spans both the peripheral and central nervous systems. These manifestations could possibly be categorised into those directly related to dengue infection, i.e. acute and chronic encephalitis, indirect complications leading to dengue encephalopathy, and post-infectious syndrome due to immune-mediated reactions, and manifestations with uncertain mechanisms such as acute transverse myelitis, acute cerebellitis, and myositis. The rising trend in global dengue incidence calls for attention to a more explicit definition of each neurological manifestation for more accurate epidemiological data. The actual global burden of dengue infection with neurological manifestation is essential for future planning and execution of strategies, especially in the development of effective antiviral and vaccines against the dengue virus. In this update, we discussed the recent findings of different spectrums of neurological manifestations in dengue infection and provided up-to-date antiviral and vaccine development and its challenges.

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Dengue fever presenting as acute cerebellar ataxia: Case report and literature review

Cited by 4 publications

References 8 publications

An Intriguing Case of Expanded Dengue Syndrome With Co-existing Encephalitis, Pancreatitis, and Hepatitis: The Classic Thalamic “Double-Doughnut” Sign Revisited

An Intriguing Case of Expanded Dengue Syndrome With Co-existing Encephalitis, Pancreatitis, and Hepatitis: The Classic Thalamic “Double-Doughnut” Sign Revisited

Delayed cerebellar ataxia induced by Plasmodium falciparum malaria: A rare complication

Dengue virus infection and neurological manifestations: an update

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