Spinal epidural hematoma with myelitis and brainstem hemorrhage: An unusual complication of dengue fever

Singh, Manmohan; Garg, Kanwaljeet; Bisht, Ajay; Sharma, Bhawani Shankar; Singh, Pankaj Kumar; Pandia, Mihir Prakash; Mahapatra, Ashok Kumar

doi:10.4103/0028-3886.121946

Cited by 13 publications

(11 citation statements)

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“…A further 136 were excluded on the basis of title and abstract and 19 studies did not meet the eligibility criteria on full text screening ( Figure 1). The remaining 25 studies were eligible and full text was assessed for inclusion in the final review [7,9,10,[12][13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Most of the studies were from Asia (76%; 19/25) and the rest from South America (24%; 6/25).…”

Section: Resultsmentioning

confidence: 99%

Risk of Transverse Myelitis Following Dengue Infection: A Systematic Review of the Literature

Badat¹,

Oligbu²

2018

Preprint

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Introduction: Dengue virus (DENV) is one of the most common arbovirus diseases, with a wide spectrum of presentation. Spinal cord involvement in dengue infection (DF) is rare. However, the risk of transverse myelitis (TM) following Dengue has not been systematically assessed. Methods: We undertook a systematic review of published English literature from January 1974 to December 2017 to assess risk of TM and outcomes following DF. Data sources included EMBASE, MEDLINE, Cochrane library, ISI web of knowledge, conference proceedings and references within identified articles. Results: We identified 242 potential studies, 62 were duplicates. A further 136 were excluded on the basis of title and abstract and 19 studies did not meet the eligibility criteria on full text screening. We included 25 publications involving 2672 cases of DF. A small proportion (10.8%, (289/2672)) had neurological complications, of which 2.3% (61/2672) was TM. For articles reporting epidemiological data, the neurological complication was twice in males compared to female 67.7% (130/192) vs. 32.7% (62/192) and 1.5-fold increase TM for males 59.3% (32/54) vs 40.7% (22/54). The mean age at presentation was 33.1years (range 0.75-61), with onset at 11.7days. The method of diagnosing TM due to DF was mainly IgM seropositivity 92% (n = 23/25) and the commonest treatment modality was steroid 78.3% (n = 18/23). Only half had full recovery 50.8% (n = 31/61). There was no mortality following dengue, however, the crude case fatality rate following TM was 3.3% (n = 2/61). Conclusion: This review highlights the risk of TM following dengue. Although neurological complications are rare, especially TM, once set in, it is associated with a significant morbidity.

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Section: Resultsmentioning

confidence: 99%

Risk of Transverse Myelitis Following Dengue Infection: A Systematic Review of the Literature

Badat¹,

Oligbu²

2018

Preprint

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“…The presenting complaints in other reports are summarized in Table 1 as well. [ 16 17 18 19 20 21 22 23 24 25 26 27 ] Overall, fever, reduced or altered consciousness, vomiting, and headache are the top complaints. Three of the patients had shock of which two died.…”

Section: Results Of Other Case Reports and Seriesmentioning

confidence: 99%

Deadly intracranial bleed in patients with dengue fever: A series of nine patients and review of literature

Sam

Gee

Nasser

2016

Journal of Neurosciences in Rural Practice

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Introduction:Dengue fever is a global pandemic threat with increasing incidence. To date, there are no cures and the effectiveness of dengue vaccines is still uncertain. World Heath Organization introduced expanded dengue syndrome to include unusual presentations of dengue fever including severe neurologic complications. One of the deadly complications is intracranial hemorrhage (ICH).Methodology:We collected data of patients with ICH diagnosed via a plain computed tomography of the brain (CT brain) with thrombocytopenia and positive Dengue virus type 1 nonstructural protein (NS1) antigen test or positive dengue serology IgM from January 2014 till June 2015 at our center. Nine patients were included and all 20 other remaining patients reported in literature so far are discussed.Discussion:We found that all patients in our center requiring neurosurgical intervention died. Another interesting observation is that detection of Dengue IgG usually meant more severe ICH and poorer outcomes. From our series, platelet levels did not seem to influence the outcome.Conclusion:We recommend that for early detection of ICH, Dengue IgG should be routinely screened and a high index of suspicion be maintained. Future research should be focused on determining predictors of ICH in patients with dengue fever so that preventive steps can be taken as mortality is high and no treatment seems beneficial at the moment once severe ICH occurs.

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“…The occurrence of brain hemorrhage in a case with dengue shock can be serious and leads to death [ 5 ]. The occurrence of brainstem hemorrhage can be a very serious fatal situation [ 6 ]. We report this case of dengue hemorrhagic fever with multiple intracranial, sub arachnoid hemorrhages and sub-dural hematoma causing brainstem herniation with respiratory depression complicated with cranial diabetes insipidus.…”

Section: Introductionmentioning

confidence: 99%

Dengue fever with diffuse cerebral hemorrhages, subdural hematoma and cranial diabetes insipidus

et al. 2016

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BackgroundNeurological manifestations in dengue fever occur in <1 % of the patients and known to be due to multisystem dysfunction secondary to vascular leakage. Occurrence of wide spread cerebral haemorrhages with subdural hematoma during the leakage phase without profound thrombocytopenia and occurrence of cranial diabetes insipidus are extremely rare and had not been reported in published literature earlier, thus we report the first case.Case presentationA 24 year old previously healthy lady was admitted on third day of fever with thrombocytopenia. Critical phase started on fifth day with evidence of pleural effusion and moderate ascites. Thirty one hours into critical phase she developed headache, altered level of consciousness, limb rigidity and respiratory depression without definite seizures. Non-contrast CT brain done at tertiary care level revealed diffuse intracranial haemorrhages and sub arachnoid haemorrhages in right frontal, parietal, occipital lobes and brainstem, cerebral oedema with an acute subdural hematoma in right temporo- parietal region. Her platelet count was 40,000 at this time with signs of vascular leakage. She was intubated and ventilated with supportive care. Later on she developed features of cranial diabetes insipidus and it responded to intranasal desmopressin therapy. In spite of above measures signs of brainstem herniation developed and she succumbed to the illness on day 8. Dengue was confirmed serologically.ConclusionsExact pathophysiological mechanism of diffuse cerebral haemorrhages without profound thrombocytopenia is not well understood. Increased awareness and high degree of clinical suspicion is needed among clinicians for timely diagnosis of this extremely rare complication of dengue fever. We postulate that immunological mechanisms may play a role in pathogenesis. However further comprehensive research and studies are needed to understand the pathophysiological mechanisms leading to this complication.

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Spinal epidural hematoma with myelitis and brainstem hemorrhage: An unusual complication of dengue fever

Cited by 13 publications

References 1 publication

Risk of Transverse Myelitis Following Dengue Infection: A Systematic Review of the Literature

Risk of Transverse Myelitis Following Dengue Infection: A Systematic Review of the Literature

Deadly intracranial bleed in patients with dengue fever: A series of nine patients and review of literature

Dengue fever with diffuse cerebral hemorrhages, subdural hematoma and cranial diabetes insipidus

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