MRI features in dengue encephalitis: A case series in South Indian tertiary care hospital

Soni, Brijesh Kumar; Das, Debasheesh S R; George, Richard A.; Aggarwal, Rohit; Sivasankar, Rajeev

doi:10.4103/ijri.ijri_322_16

Cited by 18 publications

(18 citation statements)

References 14 publications

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“…On DWI, Shah et al (2018) also described a dengue double donut sign similar to our eighth case [ 10 ]. Many authors have found involvement of the thalamus, basal ganglia, brainstem, peri-ventricular white matter, and cortex on MRI in cases of dengue encephalitis, which are similar to our findings [ 11 - 13 ].…”

Section: Discussionsupporting

confidence: 91%

The Spectrum of MRI Findings in Dengue Encephalitis

LNU¹,

Sehgal²,

Sehgal³

et al. 2022

Cureus

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BackgroundIn this study, we aimed to describe eight cases of dengue encephalitis along with their magnetic resonance imaging (MRI) findings. Dengue encephalitis is caused by an arbovirus that has four strains DENV1-DENV4. The dengue virus is usually non-neurotropic but DENV2 & DENV3 are neurotropic. Dengue encephalitis is characterized by headaches, seizures, and altered consciousness. MethodologyAt our facility, we performed 3T MRI on eight suspected cases of dengue encephalitis using the criteria established by Varatharaj et al. We were able to diagnose dengue encephalitis based on the proposed criteria which included symptoms, serology, cerebrospinal fluid (CSF) analysis results, MRI findings, and routine blood laboratory workup in dengue encephalitis. Because numerous brain regions are potentially impacted in severe cases of dengue encephalitis, an MRI of the brain can reveal the severity of the condition. In deteriorating situations, it may detect whether or not further regions are being impacted. Hence, MRI should be done in all suspected cases of dengue encephalitis. ResultsThe changes observed on MRI of the eight cases were in the supra-tentorium (deep periventricular white matter, subcortical white matter, and deep gray matter of the brain, which includes basal ganglia and thalami), infra-tentorium (cerebellar white matter and brainstem, which includes pons), and occasionally in cortical gray matter. The MRI showed mild-to-moderate hyperintensities on T2-weighted images and fluidattenuated inversion recovery sequence (FLAIR); diffusion restriction is seen on diffusion-weighted images. The neurological clinical features included non-localizing signs and symptoms such as altered mental status, headache with vomiting, and fever. ConclusionsThe commonly affected areas of the brain in dengue encephalitis are the basal ganglia, thalamus, brainstem, cerebellum, cortical white matter, periventricular white matter, and cortical gray matter, which are all hyperintense on T2-weighted images and FLAIR. The lesions are iso or hypointense on T1-weighted images and micro-hemorrhages appear as blooming on susceptibility-weighted MRI. MRI is a crucial initial investigation in suspected cases of dengue encephalitis and known cases of dengue fever experiencing worsening neurological conditions.

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Section: Discussionsupporting

confidence: 91%

The Spectrum of MRI Findings in Dengue Encephalitis

LNU¹,

Sehgal²,

Sehgal³

et al. 2022

Cureus

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“…In contrast, severe DENV and YFV infections are generally associated with systemic disease, characterized primarily by increased vasculopathy and plasma leakage from blood vessels into tissues, as well as hepatic damage/dysfunction (World Health Organization, 2009). However, there are multiple reports describing DENV-associated neurological complications such as encephalitis and DENV infection in the human brain in autopsies, as well as detection of viral antigens in placental tissues from DENV-infected mothers (Balsitis et al, 2009; Kumar et al, 2008; Ribeiro et al, 2017; Soni et al, 2017). These findings indicate that DENV may also breach the blood-brain barrier as well as reach the placenta during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Flavivirus NS1 Triggers Tissue-Specific Vascular Endothelial Dysfunction Reflecting Disease Tropism

et al. 2019

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SUMMARY Flaviviruses cause systemic or neurotropic-encephalitic pathology in humans. The flavivirus nonstructural protein 1 (NS1) is a secreted glycoprotein involved in viral replication, immune evasion, and vascular leakage during dengue virus infection. However, the contribution of secreted NS1 from related flaviviruses to viral pathogenesis remains unknown. Here, we demonstrate that NS1 from dengue, Zika, West Nile, Japanese encephalitis, and yellow fever viruses selectively binds to and alters permeability of human endothelial cells from lung, dermis, umbilical vein, brain, and liver in vitro and causes tissue-specific vascular leakage in mice, reflecting the pathophysiology of each flavivirus. Mechanistically, each flavivirus NS1 leads to differential disruption of endothelial glycocalyx components, resulting in endothelial hyperpermeability. Our findings reveal the capacity of a secreted viral protein to modulate endothelial barrier function in a tissue-specific manner both in vitro and in vivo, potentially influencing virus dissemination and pathogenesis and providing targets for antiviral therapies and vaccine development.

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“…Centre of bilateral thalami showed diffusion restriction and blooming in susceptibility weighted imaging (SWI) characteristic of “double doughnut sign” due to petechial hemorrhages. [ 1 2 ] Postcontrast T1 fat sat images revealed rim enhancement in thalamus surrounding the area of diffusion restriction/susceptibility artifact. The appearance in postcontrast images is an inverse of diffusion weighted imaging.…”

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confidence: 99%