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 common11 . 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
https://doi.org/10.1016/s1474-4422(13)70...
2 . 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
https://doi.org/10.1590/0004-282x2013014...
-33 . 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
https://doi.org/10.1016/j.jns.2013.08.02...
.
However, although unusual, patients may present with cerebral hemorrhage, particularly
in hemorrhagic dengue44 . 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
https://doi.org/10.1590/s1413-8670200500...
,55 . 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
https://doi.org/10.1159/000180305 ...
. Pathophysiology may include: capillary
hemorrhage, disseminated intravascular coagulation and cerebral edema44 . 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
https://doi.org/10.1590/s1413-8670200500...
.
References
-
1Carod-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
» https://doi.org/10.1016/s1474-4422(13)70150-9 -
2Puccioni-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
» https://doi.org/10.1590/0004-282x20130147 -
3Gupta 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
» https://doi.org/10.1016/j.jns.2013.08.029 -
4Souza 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
» https://doi.org/10.1590/s1413-86702005000300009 -
5Kumar 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
» https://doi.org/10.1159/000180305
Publication Dates
-
Publication in this collection
Oct 2014
History
-
Received
13 May 2014 -
Reviewed
27 June 2014 -
Accepted
17 July 2014