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.
References
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complications of dengue infection. Lancet Neurol. 2013;12(9):906-19.
http://dx.doi.org/10.1016/s1474-4422(13)70150-9
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complications in dengue infection: a review for clinical practice. Arq
Neuropsiquiatr. 2013;71(9B):667-71. http://dx.doi.org/10.1590/0004-282x20130147
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. 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
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. 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
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. 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
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