Encephalitis and transverse myelitis in dengue and chikungunya coinfection

Farias, Luís Arthur Brasil Gadelha; Ferragut, Juliana Mandato; Neto, Roberto da Justa Pires

doi:10.1590/0037-8682-0259-2017

Cited by 9 publications

(5 citation statements)

References 3 publications

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“… 1 There is a case report, during the Brazilian epidemic, of predilection for the anterior horn of the spinal cord in a case of chikungunya and dengue coinfection, associated with acute transverse myelitis. 4 The neuroimaging findings of patients with clinical signs of encephalitis or encephalopathy are also unspecific and variable. There are descriptions of edema or non-specific hemorrhage on brain computed tomography; there are also hyperintensities in T2WI and FLAIR and abnormal restricted diffusion on DWI in several areas on brain MRI, but many cases do not show any abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“Clock dial pattern”, a radiologic clue to neuro-chikungunya diagnosis: a case series

Fraiman,

Freire,

Fernandes

et al. 2024

Arq Neuropsiquiatr

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Background Chikungunya is a mosquito-borne disease caused by the chikungunya virus (CHIKV) and can lead to neurological complications in severe cases. Objective This study examined neuroimaging patterns in chikungunya cases during two outbreaks in Brazil to identify specific patterns for diagnosis and treatment of neuro-chikungunya. Methods Eight patients with confirmed chikungunya and neurological involvement were included. Clinical examinations and MRI scans were performed, and findings were analyzed by neuroradiologists. Data on age, sex, neurological symptoms, diagnostic tests, MRI findings, and clinical outcomes were recorded. Results Patients showed different neuroimaging patterns. Six patients exhibited a “clock dial pattern” with hyperintense dotted lesions in the spinal cord periphery. One patient had thickening and enhancement of anterior nerve roots. Brain MRI revealed multiple hyperintense lesions in the white matter, particularly in the medulla oblongata, in six patients. One patient had a normal brain MRI. Conclusion The “clock dial pattern” observed in spinal cord MRI may be indicative of chikungunya-related nervous system lesions. Isolated involvement of spinal cord white matter in chikungunya can help differentiate it from other viral infections. Additionally, distinct brainstem involvement in chikungunya-associated encephalitis, particularly in the rostral region, sets it apart from other arboviral infections. Recognizing these neuroimaging patterns can contribute to early diagnosis and appropriate management of neuro-chikungunya.

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Section: Discussionmentioning

confidence: 99%

“Clock dial pattern”, a radiologic clue to neuro-chikungunya diagnosis: a case series

Fraiman,

Freire,

Fernandes

et al. 2024

Arq Neuropsiquiatr

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“…Of those, 32 patients were male, and the mean age of presentation was 33.1 years, with an average time of 11.7 days from dengue to the first onset of neurological symptoms of transverse myelitis [4]. We have tabulated the reported cases of transverse myelitis complicated by dengue fever reported after 2018 (Table 3) [3,[7][8][9][10][11]. The pathophysiology of dengue fever-induced transverse myelitis is not yet defined.…”

Section: Discussionmentioning

confidence: 99%

Acute Transverse Myelitis as an Unusual Complication of Dengue Fever: A Case Report and Literature Review

Karishma,

Harsha,

Rani

et al. 2024

Cureus

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Dengue fever, the most prevalent arbovirus disease, has a broad spectrum of clinical manifestations, ranging from asymptomatic to dengue hemorrhagic fever and dengue shock syndrome. Dengue fever has the potential to involve the nervous system. Acute transverse myelitis is a life-threatening complication of dengue fever, though rarely reported. We report a case of dengue fever-induced transverse myelitis in a 51-year-old male who presented with progressive paraplegia, sensory disturbance, and urinary retention preceded by a febrile illness, vomiting, and retro-orbital pain two weeks before. His serology was positive for immunoglobulin M (IgM) to dengue virus and non-structural protein (NS-1). Magnetic resonance imaging revealed hyperintense signals suggestive of acute transverse myelitis. After ruling out all other possible causes, a possible diagnosis of dengue fever-induced transverse myelitis was made. His condition improved gradually after starting methylprednisolone.

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“…The most frequently observed complication is encephalitis, followed by myelitis, encephalomyelitis, Guillain-Barré syndrome, acute disseminated encephalomyelitis, optic neuropathy, and neuroretinitis. Less frequently reported complications include seizures, sensorineural hearing loss, stroke, cerebellitis, meningism, cranial nerve palsy, carpal tunnel syndrome, ophthalmoplegia, and disorientation 8,[10][11][12][13][14] .…”

Section: Neurological Manifestationsmentioning

confidence: 99%

Extra-articular Manifestations of Chikungunya

Oliveira,

Nogueira,

Amaral

et al. 2023

Rev. Soc. Bras. Med. Trop.

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Chikungunya fever (CHIK) is a neglected tropical disease associated with chronic arthritis. CHIK is usually a self-limiting condition; however, extra-articular manifestations present as atypical illness in a minority of patients. These atypical features may mimic other conditions and potentially distract physicians from the true diagnosis. This review analyzes the evidence of many unusual extra-articular manifestations reported in cases of CHIK. Depending on the affected system, these unusual manifestations include encephalitis, myocarditis, acute interstitial nephritis, cutaneous manifestations, acute anterior uveitis, abdominal pain, and depression. In addition, coinfections and comorbidities may cause atypical illness and obscure the diagnosis. Further studies are required to clarify the pathophysiology and natural history of CHIK, as it remains a burdening condition. Exploring its atypical symptoms may be the missing scientific piece of this puzzle.

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Encephalitis and transverse myelitis in dengue and chikungunya coinfection

Cited by 9 publications

References 3 publications

“Clock dial pattern”, a radiologic clue to neuro-chikungunya diagnosis: a case series

“Clock dial pattern”, a radiologic clue to neuro-chikungunya diagnosis: a case series

Acute Transverse Myelitis as an Unusual Complication of Dengue Fever: A Case Report and Literature Review

Extra-articular Manifestations of Chikungunya

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