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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2015; 25(01): 52-55
DOI: 10.4103/0971-3026.150145
Neuroradiology

Acute hemorrhagic encephalitis: An unusual presentation of dengue viral infection

Jeyaseelan Nadarajah
Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India
,
Kumble Seetharama Madhusudhan
Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India
,
Ajay Kumar Yadav
Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India
,
Arun Kumar Gupta
Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India
,
Naval Kishore Vikram
Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Dengue is a common viral infection worldwide with presentation varying from clinically silent infection to dengue fever, dengue hemorrhagic fever, and severe fulminant dengue shock syndrome. Neurological manifestation usually results from multisystem dysfunction secondary to vascular leak. Presentation as hemorrhagic encephalitis is very rare. Here we present the case of a 13-year-old female admitted with generalized tonic clonic seizures. Plain computed tomography (CT) scan of head revealed hypodensities in bilateral deep gray matter nuclei and right posterior parietal lobe without any hemorrhage. Cerebrospinal fluid (CSF) and serology were positive for IgM and IgG antibodies to dengue viral antigen. Contrast-enhanced magnetic resonance imaging (MRI) revealed multifocal T2 and fluid attenuated inversion recovery (FLAIR) hyperintensities in bilateral cerebral parenchyma including basal ganglia. No hemorrhage was seen. She was managed with steroids. As her clinical condition deteriorated, after being stable for 2 days, repeat MRI was done which revealed development of hemorrhage within the lesions, and diagnosis of acute hemorrhagic encephalitis of dengue viral etiology was made.

Keywords

Cerebral hemorrhage - dengue - diffusion-weighted images - Dengue hemorrhagic encephalopathy - encephalitis


Publication History

Article published online:
30 July 2021

© 2015. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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