Spontaneous intracranial hemorrhage associated with dengue fever: An emerging concern for general physicians

A Critical Analysis of Intracranial Hemorrhage as a Fatal Complication of Dengue Fever

Dengue fever is the most rapidly spreading mosquito-borne virus in the world, infecting about 100 million individuals. A rare but possibly dangerous consequence of dengue illness is intracranial hemorrhage (ICH). Currently, the pathogenesis of ICH is unknown. A number of studies have found a variety of risk factors for ICH in dengue. In addition, studies have reported the use of emergency surgery while monitoring thrombocytopenia in the therapy of dengue ICH. This review enumerates the potential predictors of ICH in dengue, discusses the use of brain imaging, and mentions the possibility of emergency surgery.

Long-Segment Epidural Hemorrhage of the Cervical and Dorsal Spine: A Case Report of a Rare Complication of Dengue Virus Disease

Dengue hemorrhagic fever is a severe form of dengue virus disease, characterized by minor to major bleeding, thrombocytopenia, and plasma leakage. Common hemorrhagic manifestations include epistaxis, gum bleeding, gastrointestinal bleeding, hypermenorrhea, and hematuria. Intracranial hemorrhage is one of the most fatal manifestations of central nervous system involvement by dengue disease which is a part of the expanded dengue syndrome. Here we present a case of A 37-year-old male patient who presented with complaints of intermittent high-grade fever and generalized weakness four days prior to consultation. Laboratory investigations revealed mild thrombocytopenia and positive dengue serology. Magnetic resonance imaging of the brain and spine revealed mild diffuse subarachnoid hemorrhage in bilateral parieto-occipital lobes with long segment cervical and dorsal spinal epidural hemorrhage.

Spontaneous acute subdural hematoma in dengue fever: Case report and review of the literature

Introduction and importance

A very uncommon dengue fever consequence is subdural hematoma. IgG positivity, increased AST, and ALT levels may all be risk factors for bleeding in dengue fever patients.

Case presentation

We report the case of a 65-year-old man who presented with dengue fever symptoms and developed altered consciousness and focal neurological deficits. The findings of the tests showed thrombocytopenia, increased AST and ALT, positive anti-dengue IgG, and subdural hematoma on brain imaging. The urgent operations were completed satisfactorily.

Clinical discussion

Dengue-related intracerebral haemorrhage is still a complicated condition. Thrombocytopenia and leukopenia are the first symptoms that point to dengue. Some risk factors, such as thrombocytopenia and increased AST and ALT, have been identified as bleeding factors in dengue fever. For a possible intracerebral haemorrhage, radiological imaging should be performed. In an emergency neurosurgery setting, thrombocyte administration could be used to monitor thrombocytopenia.

Conclusion

Subdural hematoma is a possible dengue fever complication. If the patient's symptoms with thrombocytopenia and elevated liver enzymes indicate the possibility of intracranial haemorrhage, immediate radiological imaging should be performed.

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Elevated AST and ALT as a risk factor of intracranial bleeding in dengue fever

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Immediate radiological imaging to the patients with positive IgG and intracranial haemorrhage symptoms.

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Emergency surgical intervention should be conducted depending on patient's status with thorough care in hematologic profile.

Neurological Complications of Dengue Fever

PURPOSE OF REVIEW

To discuss the neurological complications of dengue virus (DENV) infection and their pathogenesis.

RECENT FINDINGS

Include recognition of the four different serotypes of DENV and their epidemiology as well as recognition of the expanded dengue syndrome encompassing multisystem involvement in the severe form of the disease including involvement of the central nervous system (CNS). DENV is a neurotropic virus with the ability to infect the supporting cells of the CNS. Neural injury during the acute stage of the infection results from direct neuro-invasion and/or the phenomenon of antibody-dependent enhancement, resulting in plasma leakage and coagulopathy. Immune mechanisms have been implicated in the development of the delayed neurological sequelae through molecular mimicry. A myriad of neurological syndromes has been described as a result of the involvement of the CNS, the peripheral nervous system (PNS), or both. Neurological manifestations in DENV infection are increasingly being recognized, some of which are potentially fatal if not treated promptly. DENV encephalopathy and encephalitis should be considered in the differential diagnosis of other acute febrile encephalopathies, autoimmune encephalitides, and in cases of encephalopathy/encephalitis related to SARS-CoV2 infection, especially in dengue-endemic areas. Acute disseminated encephalomyelitis (ADEM) may be occasionally encountered. Clinicians should be knowledgeable of the expanded dengue syndrome characterized by the concurrent compromise of cardiac, neurological, gastrointestinal, renal, and hematopopoietic systems. Isolated cranial nerve palsies occur rather uncommonly and are often steroid responsive. These neuropathies may result from the direct involvement of cranial nerve nuclei or nerve involvement or may be immune-mediated. Even if the diagnosis of dengue is confirmed, it is absolutely imperative to exclude other well-known causes of isolated cranial nerve palsies. Ischemic and hemorrhagic strokes may occur following dengue fever. The pathogenesis may be beyond the commonly observed thrombocytopenia and include cerebral vasculitis. Involvement of ocular blood vessels may cause maculopathy or retinal hemorrhages. Posterior reversible encephalopathy syndrome (PRES) is uncommon and possibly related to dysregulated cytokine release phenomena. Lastly, any patient developing acute neuromuscular weakness during the course or within a fortnight of remission from dengue fever must be screened for acute inflammatory demyelinating polyneuropathy (AIDP), hypokalemic paralysis, or acute myositis. Rarely, a Miller-Fisher-like syndrome with negative anti-GQ1b antibody may develop.

Rare case of Terson's syndrome and viral retinitis due to dengue haemorrhagic fever in an infant

Dengue haemorrhagic fever with consequent thrombocytopaenia can lead to intracranial haemorrhage and Terson's syndrome that can lead to visual problems. Simultaneously, the dengue virus can cause typical viral retinitis like picture in the eye. Early funduscopy and vision assessment is desirable in all dengue patients. In our case, an infant with dengue haemorrhagic fever and intracranial haemorrhage developed not only simultaneous bilateral vitreous and subinternal limiting membrane haemorrhage due to Terson's syndrome from the indirect effect of thrombocytopaenia but also typical chorioretinitis possibly due to the direct effect of the virus on the retina. The vitreoretinal surgical outcome was satisfactory in this case.