Acute Subdural Hematoma in a Patient with Dengue – Case Report and Review of Literature

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

“…Complex mechanisms underlie the susceptibility of dengue-infected patients to ICH. The pathophysiology of neurological involvement includes virus-induced direct tissue lesions, capillary haemorrhage, disseminated intravascular coagulation, metabolic disorders, fulminant liver failure, and cerebral edema caused by increased vascular permeability [ 54 ]. Dengue causes intracerebral haemorrhage due to thrombocytopenia and abnormal bleeding parameters [ 21 ].…”

“…25) In contrast, other study concluded that a combination of biphasic fever patterns, haemoconcentration, thrombocytopenia (<50,000/mm3), and elevated ALT had a 70% positive predictive value and a 75% negative predictive value for predicting spontaneous bleeding in dengue. 54) As Jayasinghe et al reported, Jayasinghe et al reported that a platelet count below 40,000/mm3 was associated with multiple cerebral haemorrhages and subdural hematoma in patients with dengue fever. 13) Talukdar et al identified three risk factors for plasma leakage: Body Mass Index (BMI) ≥25.0 kg/m 2 , platelet count <100,000/mm 3 on fever days 3 to 4, and elevated AST and ALT (≥100 U/I) on fever days 3 or 4.…”

“…The pathophysiology of neurological involvement includes virus-induced direct tissue lesions, capillary haemorrhage, disseminated intravascular coagulation, metabolic disorders, fulminant liver failure, and cerebral edema caused by increased vascular permeability. 54) Dengue causes intracerebral haemorrhage due to thrombocytopenia and abnormal bleeding parameters. 21) The proposed mechanism underlying intracerebral haemorrhage in dengue infection is primarily associated with haemostatic disorders.…”

“…10) Several studies have also reported the success of surgical intervention in the treatment of ICH in dengue. 10,23,26,51,54,56) However, Sam et al reported that two surgical patients died from excessive bleeding during the procedure. 44) Typically, patients who received a conservative intervention due to low platelet counts.…”

Burden of dengue-related neurosurgical emergencies during an epidemic: A tertiary care experience

“…Spontaneous intracranial bleeds are among the most common neurosurgical emergencies related to dengue reported in the literature. [ 7 8 9 10 11 12 ] The deleterious effects it has on the brain is without doubt. The management of such complications is a conundrum, as surgery in dengue coagulopathy is detrimental.…”