Generalized Dystonia/Parkinsonism and <scp>Double‐Doughnut</scp> Sign in Dengue Encephalitis

Mishra, Anumeha; Pandey, Sanjay

doi:10.1002/mdc3.12959

Cited by 6 publications

(9 citation statements)

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“…For patients with a clinical diagnosis of parkinsonism, symptom onset occurred immediately after or concurrently with the critical phase of a severe dengue fever [ 88 – 91 ]. Additionally, three of the seven clinically diagnosed patients in the studies tested positive for IgG which indicates a likely secondary infection [ 24 , 89 , 92 ]. No patient deaths were reported [ 24 , 88 – 91 , 93 ], but one outcome was not described [ 92 ].…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, three of the seven clinically diagnosed patients in the studies tested positive for IgG which indicates a likely secondary infection [ 24 , 89 , 92 ]. No patient deaths were reported [ 24 , 88 – 91 , 93 ], but one outcome was not described [ 92 ]. All patients with a diagnosis of parkinsonism also had severe DENV as defined by the World Health Organization [ 7 ].…”

Section: Resultsmentioning

confidence: 99%

“…Symptoms for the clinical case group were expressionless face in 5 of 7 cases ( Table 5 ), [ 88 , 89 , 91 – 93 ]. Two of seven experienced imbalance [ 24 , 93 ] and four of seven had confusion ( Table 5 ), [ 89 – 92 ]. Of the seven case studies, six had slurring of speech ( Table 5 ), [ 24 , 88 – 91 , 93 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of the seven case studies, six had slurring of speech ( Table 5 ), [ 24 , 88 – 91 , 93 ]. Six had slow movements [ 24 , 88 – 91 , 93 ], four had tremors/dystonia [ 24 , 90 – 92 ] and five had gait issues ( Table 5 ), [ 24 , 88 , 89 , 91 , 93 ]. Four case studies reported stiffness/rigidity ( Table 5 ), [ 88 , 90 , 91 , 93 ].…”

Section: Resultsmentioning

confidence: 99%

“…MRI findings were normal for all but three patients with a clinical diagnosis of parkinsonism. One of which had microinfarcts of the basal ganglia [ 90 ] and the other had a double-doughnut sign that is typical of dengue encephalitis [ 92 ]. Another patient had brain atrophy [ 91 ].…”

Section: Resultsmentioning

confidence: 99%

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Viral Parkinsonism: An underdiagnosed neurological complication of Dengue virus infection

2022

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Dengue virus (DENV) is a flavivirus that is a significant cause of human disease costing billions of dollars per year in medical and mosquito control costs. It is estimated that up to 20% of DENV infections affect the brain. Incidence of DENV infections is increasing, which suggests more people are at risk of developing neurological complications. The most common neurological manifestations of DENV are encephalitis and encephalopathy, and movement disorders such as parkinsonism have been observed. Parkinsonism describes syndromes similar to Parkinson’s Disease where tremors, stiffness, and slow movements are observed. Parkinsonism caused by viral infection is characterized by patients exhibiting at least two of the following symptoms: tremor, bradykinesia, rigidity, and postural instability. To investigate DENV-associated parkinsonism, case studies and reports of DENV-associated parkinsonism were obtained from peer-reviewed manuscripts and gray literature. Seven reports of clinically diagnosed DENV-associated parkinsonism and 15 cases of DENV encephalitis, where the patient met the case criteria for a diagnosis of viral parkinsonism were found. Clinically diagnosed DENV-associated parkinsonism patients were more likely to be male and exhibit expressionless face, speech problems, and lymphocytosis. Suspected patients were more likely to exhibit tremor, have thrombocytopenia and low hemoglobin. Viral parkinsonism can cause a permanent reduction in neurons with consequential cognitive and behavior changes, or it can leave a latent imprint in the brain that can cause neurological dysfunction decades after recovery. DENV-associated parkinsonism is underdiagnosed and better adherence to the case definition of viral parkinsonism is needed for proper management of potential sequalae especially if the patient has an ongoing or potential to develop a neurodegenerative disease.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Viral Parkinsonism: An underdiagnosed neurological complication of Dengue virus infection

2022

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Video Anthology of Movement Disorders Due to Infections in South Asia

Aggarwal

Adukia

Bhatt

2021

Movement Disord Clin Pract

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South Asia, encompassing many populous countries including India, Pakistan, and Bangladesh, is home to a wide variety of infectious diseases several of which are disproportionately prevalent, endemic or distinctive to the region. These result in considerable morbidity and mortality, which can be greatly reduced through public‐health measures, timely diagnosis and treatment. Some of these infectious diseases have neurological manifestations including movement disorders either due to the pathogen being neuroinvasive or via an immune‐mediated response. For diseases such as Japanese encephalitis, movement disorders are the primary manifestation while for others, they can be a presenting feature. Thus, recognizing these movement disorders is often crucial to the diagnosis of the particular infection, and/or to exclude infection as a cause and arrive at the correct alternate diagnosis. Once diagnosed, the infection‐related movement disorders are treated by targeting the infectious agent, or symptomatically. In this article, we describe and illustrate a variety of movement disorders that are seen in patients infected by viruses, bacteria and parasites in South Asia. This would be of value to neurologists practicing in the region and, with the increasing ease in movement of people and pathogens, those practicing elsewhere.

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Review of dengue, zika and chikungunya infections in nervous system in endemic areas

Puccioni-Sohler,

Nascimento Soares,

Christo

et al. 2023

Arq Neuropsiquiatr

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Dengue, zika, and chikungunya are arboviruses of great epidemiological relevance worldwide. The emergence and re-emergence of viral infections transmitted by mosquitoes constitute a serious human public health problem. The neurological manifestations caused by these viruses have a high potential for death or sequelae. The complications that occur in the nervous system associated with arboviruses can be a challenge for diagnosis and treatment. In endemic areas, suspected cases should include acute encephalitis, myelitis, encephalomyelitis, polyradiculoneuritis, and/or other syndromes of the central or peripheral nervous system, in the absence of a known explanation. The confirmation diagnosis is based on viral (isolation or RT-PCR) or antigens detection in tissues, blood, cerebrospinal fluid, or other body fluids, increase in IgG antibody titers between paired serum samples, specific IgM antibody in cerebrospinal fluid and serological conversion to IgM between paired serum samples (non-reactive in the acute phase and reactive in the convalescent). The cerebrospinal fluid examination can demonstrate: 1. etiological agent; 2. inflammatory reaction or protein-cytological dissociation depending on the neurological condition; 3. specific IgM, 4. intrathecal synthesis of specific IgG (dengue and chikungunya); 5. exclusion of other infectious agents. The treatment of neurological complications aims to improve the symptoms, while the vaccine represents the great hope for the control and prevention of neuroinvasive arboviruses. This narrative review summarizes the updated epidemiology, general features, neuropathogenesis, and neurological manifestations associated with dengue, zika, and chikungunya infection.

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Generalized Dystonia/Parkinsonism and Double‐Doughnut Sign in Dengue Encephalitis

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Cited by 6 publications

References 5 publications

Viral Parkinsonism: An underdiagnosed neurological complication of Dengue virus infection

Viral Parkinsonism: An underdiagnosed neurological complication of Dengue virus infection

Video Anthology of Movement Disorders Due to Infections in South Asia

Review of dengue, zika and chikungunya infections in nervous system in endemic areas

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