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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.72 no.10 São Paulo Oct. 2014

https://doi.org/10.1590/0004-282X20140131 

Images in Neurology

Dengue virus infection presenting with diffuse brain hemorrhage

Infecção pelo virus da dengue se apresentando com hemorragia cerebral difusa

Ricardo Tavares Daher 1  

Victor Hugo Rocha Marussi 1  

José Luiz Pedroso 2  

Acary Souza Bulle Oliveira 2  

Lázaro Luiz Faria do Amaral 1  

1Med Imagem, Hospital Beneficência Portuguesa de São Paulo, Sao Paulo SP, Brazil;

2Departamento de Neurologia, Universidade Federal de São Paulo, Sao Paulo SP, Brazil.


A 40-year-old woman presented to the emergency department with acute decreased level of consciousness, associated with respiratory failure. She has complained of headache, fever, myalgia and dyspnea for the last seven days. Neurological examination disclosed decreased level of consciousness. Brain CT scan disclosed multiple intracerebral acute hemorrhage lesions (Figure). After extensive investigation, serologic test confirmed Dengue virus infection.

Brain involvement in dengue virus infection may have variable presentation, and encephalitis is the most common1-3. However, although unusual, patients may present with cerebral hemorrhage, particularly in hemorrhagic dengue4,5. Pathophysiology may include: capillary hemorrhage, disseminated intravascular coagulation and cerebral edema4.

Figure Axial brain CT scan discloses bilateral and asymmetrical subcortical (straight arrows) and pericallosal (curved arrows) hemorrhage predominant in frontal and temporal lobes. 

References

. Carod-Artal FJ, Wichmann O, Farrar J, Gascón J. Neurological complications of dengue infection. Lancet Neurol. 2013;12(9):906-19. http://dx.doi.org/10.1016/s1474-4422(13)70150-9 [ Links ]

. Puccioni-Sohler M, Rosadas C, Cabral-Castro MJ. Neurological complications in dengue infection: a review for clinical practice. Arq Neuropsiquiatr. 2013;71(9B):667-71. http://dx.doi.org/10.1590/0004-282x20130147 [ Links ]

. Gupta M, Nayak R, Khwaja GA, Chowdhury D. Acute disseminated encephalomyelitis associated with dengue infection: a case report with literature review. J Neurol Sci. 2013;335(1-2):216-8. http://dx.doi.org/10.1016/j.jns.2013.08.029 [ Links ]

. Souza LJ, Martins AL, Paravidini PC, Nogueira RM, Gicovate Neto C, Bastos DA et al. Hemorrhagic encephalopathy in dengue shock syndrome: a case report. Braz J Infect Dis. 2005;9(3):257-61. http://dx.doi.org/10.1590/s1413-86702005000300009 [ Links ]

. Kumar R, Prakash O, Sharma BS. Dengue hemorrhagic fever: a rare presentation as atypical acute subdural hematoma. Pediatr Neurosurg. 2008;44(6):490-2. http://dx.doi.org/10.1159/000180305 [ Links ]

Received: May 13, 2014; Revised: June 27, 2014; Accepted: July 17, 2014

Correspondence: Ricardo Tavares Daher, Hospital Beneficência Portuguesa de São Paulo; Rua Maestro Cardim, 968; 01323-001 São Paulo SP, Brasil; Email: ricardotdaher@hotmail.com

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.