Cortical laminar necrosis in dengue encephalitis—a case report

Abstract

BackgroundDengue encephalitis is a rare neurological manifestation of dengue fever. Its clinical presentation is similar to other viral encephalitides and encephalopathy. No single specific finding on magnetic resonance imaging of dengue encephalitis has yet been documented. They are highly variable and atypical.Case presentationA 15-year boy presented with fever, the headache and altered sensorium of 12-day duration. On neurological examination, his Glasgow Coma Scale score was 10 (E3M4V3). There was no focal neurological deficit. Laboratory evaluation revealed leukopenia and marked thrombocytopenia. Dengue virus IgM antibody was positive both in serum and cerebrospinal fluid. Magnetic resonance imaging of the brain revealed signal changes in bilateral parietooccipital and left frontal regions (left hemisphere more involved than the right hemisphere). There was gyriform enhancement bilateral parietooccipital regions consistent with cortical laminar necrosis. Bilaterally diffuse subcortical white matter was also involved and subtle T2 hyperintensity involving both basal ganglia was noted. Gradient echo sequence revealed presence of hemorrhage in the subcortical white matter. Patient was treated conservatively and received platelet transfusion. Patient became fully conscious after 7 days.ConclusionIn a patient with highly suggestive dengue e\ephalitis, we describe an unusual magnetic resonance imaging finding. This report is possibly the first instance of cortical laminar necrosis in such a setting.

Neurological Manifestations of Dengue Infection

“…In case of abnormal neuroimaging findings, magnetic resonance imaging (MRI) has advantages over cranial computed tomography (CT) in revealing cerebral lesions in dengue encephalitis. However, changes are usually non-specific (Garg et al, 2017 ). Decisive characterizations of MRI properties in dengue encephalitis remain undefined (Mathew et al, 2015 ).…”

A Case Series of Severe Dengue with Neurological Presentation in Children from a Colombian Hyperendemic Area

“…Despite previous studies reported that brain tissue damage is detectable by tomography images, the children described in this work did not present anomalies. Although it is preferable to use magnetic resonance for brain evaluation because of the accuracy of this technique, regularly imaging abnormalities during dengue encephalitis are not specific [ 28 ] and are still poorly defined [ 29 , 30 ], although ischemia or hemorrhage must be sought [ 31 ]. On the other hand, we found normal leukocyte counts instead of the classical leukopenia of dengue with warning signs or severe dengue, which pose a difficulty to early diagnosis, although there was thrombocytopenia only at day six of hospitalization with no changes in ALT and AST transaminases as reported previously.…”

Neurological Presentation of Severe Dengue in Children From a Colombian Hyperendemic Area

“…Although it is preferable to use magnetic resonance for brain evaluation because the accuracy of this technique, but regularly imaging abnormalities during dengue encephalitis are not speci c [28] and are still poorly de ned [29,30], although ischemia or hemorrhages must be sought. On the other hand, we found normal leukocyte counts instead of the classical leukopenia of the dengue warning signs or severe dengue, which pose a di culty to early diagnosis, although there was thrombocytopenia only at day six of hospitalization with no changes in ALT and AST transaminases as reported previously.…”