Spontaneous haemorrhagic stroke associated with expanded dengue syndrome: a case report
DOI:
https://doi.org/10.18203/2349-3933.ijam20230704Keywords:
Haemorrhagic stroke, Expanded dengue syndrome, DHF, Intracerebral haemorrhage, Subarachnoid haemorrhageAbstract
The term "expanded dengue syndrome" was introduced to describe the severe clinical manifestations that result from dengue fever (DF), namely severe multi-organ involvement including disorders of the nervous system. Neurological complications occur in 1-5% of dengue patients, including haemorrhagic stroke. A 68-year-old man presented with complaints of full-body convulsions for 1 minute. Four days earlier the patient complained of headache, fever, and nausea. Non-contrast CT scan of the head showed abnormal hyperdense lesions with focal intraparenchymal oedema in the frontoparietoocipital region, cortical sulci and gyri appeared dilated, ventricular system and sisterna were dilated. Anti-dengue IgG and IgM were positive. Neuropathogenesis that may play an important role in dengue-related neurological syndromes include direct CNS invasion by the virus, autoimmune reactions, and metabolic changes. The diagnosis of neurological complications related to dengue haemorrhagic fever (DHF) requires special attention, especially for areas where DF is still endemic.
References
Wee Cheo S, Jian Low Q, Kian Ng E, Kang Chia Y, Shan Rajahram G. Fatal subarachnoid haemorrhage in a patient with severe dengue. Med J Malaysia. 2021;76(1):107-9.
Singh J, Dinkar A, Atam V. Intracranial Hemorrhage in Dengue Fever: A Case Series Immunochromatographic Test (ICT) Kit Development for Typhoid View Project Drug Trial View Project Intracranial Hemorrhage in Dengue Fever: A Case Series. 2010;1.
Trivedi S, Chakravarty A. Neurological Complications of Dengue Fever. Curr Neurol Neurosci Rep. 2022;22(8):515-29.
Chang K, Huang CH, Chen TC, Lin CY, Lu PL, Chen YH. Clinical characteristics and risk factors for intracranial haemorrhage or infarction in patients with dengue. J Microbiol Immunol Infect. 2021;54(5):885-92.
Ee SJ, Sheng GT, Wahab NA. Deadly intracranial bleed in patients with dengue fever: A series of nine patients and review of literature. J Neurosci Rural Pract. 2016;7(3):423-34.
Seo JS, Nam TK, Kwon JT, Park YS. Multiple Spontaneous Simultaneous Intracerebral Hemorrhages. J Cerebrovasc Endovasc Neurosurg. 2014;16(2):104.
Vincent AB, Hadi U, Arifijanto MV. Expanded Dengue Syndrome. Curr Internal Med Res Pract Surabaya J. 2022;3(1):26.
Jayasinghe HMAU, Pinto V, Jayasinghe arachchi T, Wasala WMASB, Abeygunawardane S, Dissanayake D. Expanded Dengue Syndrome: A Case of Subarachnoid Haemorrhage, Cranial Diabetes Insipidus, and Haemophagocytic Lymphohistiosis. Case Rep Infect Dis. 2021;2021:1-3.
Rajapakse S, Wattegama M, Weeratunga P, Sigera PC, Fernando SD. Beyond thrombocytopaenia, haemorrhage and shock: the expanded dengue syndrome. Pathog Glob Health. 2018;112(8):404-14.
Centre for Diseases Control and Prevention (CDC). Dengue Clinical Case Management E-Learning Learn More National Center for Emerging and Zoonotic Infectious Diseases Bleeding Manifestations in Patients with Dengue Hemorrhage. Available at: https://www.cdc.gov/dengue/training/cme.html. Accessed on 30 January, 2023.
Singh A, Balasubramanian V, Gupta N. Spontaneous intracranial haemorrhage associated with dengue fever: An emerging concern for general physicians. J Family Med Prim Care. 2018;7(3):618.
Jayasinghe NS, Thalagala E, Wattegama M, Thirumavalavan K. Dengue fever with diffuse cerebral haemorrhages, subdural haematoma and cranial diabetes insipidus. BMC Res Notes. 2016;9(1):1-4.
Rao R, Nayak S, Pandey AK, Kamath SU. Diagnostic performance of C-reactive protein level and its role as a potential biomarker of severe dengue in adults. Asian Pac J Trop Med. 2020;13(8):358-65.
Vuong NL, le Duyen HT, Lam PK. C-reactive protein as a potential biomarker for disease progression in dengue: A multi-country observational study. BMC Med. 2020;18(1).
Abdrhman B, Saeed O. Natural regulatory anticoagulants proteins among Sudanese patients with dengue virus infection. Int J Health Sci (Qassim). 2017;11(2):3-8.
Bandzouzi PEGS, Mbaki HBE, Latou DHM. Multifocal Spontaneous Intracerebral Hemorrhage about a Case and Review of the Literature. Neurosci Med. 2020;11(01):12-19.
Doria JW, Forgacs PB. Incidence, Implications, and Management of Seizures Following Ischemic and Hemorrhagic Stroke. Curr Neurol Neurosci Rep. 2019;19(7).
Eko PT. Nyeri Kepala Pada Perdarahan Subaraknoid. Medicina. 2015;45:3.
Kwon SM, Choi KS, Yi HJ. Impact of brain atrophy on 90-day functional outcome after moderate-volume basal ganglia haemorrhage. Sci Rep. 2018;8(1).
