Paralytic squint due to abducens nerve palsy : a rare consequence of dengue fever

Abstract

BackgroundDengue fever is an endemic illness in the tropics with early and post infectious complications affecting multiple systems. Though neurological sequelae including mononeuropathy, encephalopathy, transverse myelitis, polyradiculopathy, Guillain-Barre syndrome , optic neuropathy and oculomotor neuropathy have been reported in medical literature, the abducens nerve despite its notoriety in cranial neuropathies in a multitude of condition due to its long intracranial course had not been to date reported to manifest with lateral rectus paralysis following dengue.Case presentationA previously well 29 year old male with serologically confirmed dengue hemorrhagic fever developed symptomatic right lateral rectus palsy during the critical phase of the illness, which persisted into convalescence and post convalescence with proven deficit on Hess screen. Alternate etiologies were excluded by imaging, serology and electrophysiology.ConclusionsThe authors detail the first reported case of abducens nerve palsy complicating dengue fever in a previously healthy male from Sri Lanka. In a tropical country with endemic dengue infections, dengue related abducens neuropathy may be considered as a differential diagnosis in cases of acquired lateral rectus palsy after dengue fever.

Syphilitic hepatitis: Look for raised alkaline phosphatase level

“…2 The most consistent abnormality in case of syphilitic hepatitis is disproportionately raised serum alkaline phosphatase levels. 3 This case highlights the importance of looking for disproportionate increase in serum alkaline phosphatase levels in suspected syphilitic hepatitis and the rare occurrence of syphilitic hepatitis in secondary syphilis with concomitant primary syphilis. Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/mjafi r e f e r e n c e s Letter to the Editor…”

“…Considering cranial nerve controlling ocular movement, there is a recent report by Shivanthan et al on abducens nerve palsy. 3 Shivanthan et al noted that ''dengue related abducens neuropathy may be considered as a differential diagnosis in cases of acquired lateral rectus palsy after dengue fever''. 3 It is no doubt that rectal palsy can be seen in dengue, however, the myth is on the pathophysiology.…”

“…3 Shivanthan et al noted that ''dengue related abducens neuropathy may be considered as a differential diagnosis in cases of acquired lateral rectus palsy after dengue fever''. 3 It is no doubt that rectal palsy can be seen in dengue, however, the myth is on the pathophysiology. Indeed, mononeuropathy can be seen after dengue and the immunopathological process is usually mentioned.…”

Paralytic squint in dengue fever- a report of three cases: Further reports of a rare, once before reported phenomenon of abducens palsy in dengue

“…Only one case report from Sri Lanka predates this brief case series documenting a proven case of spontaneously resolving abducens palsy following dengue during the mid-2011 epidemic in the island. [1] A variety of mononeuropathies following dengue have been observed in Sri Lanka as well as globally, but inadequate investigative facilities often fail to exclude other possible causes and hence reluctance by observers to report such cases.…”

Neurological manifestations of dengue viral infection

“…Optic neuritis, oculomotor nerve palsy, isolated sixth nerve palsy, isolated Bell's palsy, long thoracic neuropathy, and isolated phrenic nerve palsy causing diaphragmatic paralysis have been described. [27][28][29][30][31][32][33][34][35] Polyradiculoneuritis and GBS Cases of acute polyradiculoneuritis, lumbosacral plexopathy, GBS, and Miller Fisher syndrome have been reported following DENV infection. [36][37][38][39][40][41][42] The clinical picture of dengueassociated GBS consists of acute and progressive weakness affecting distal-to-proximal muscles in both lower and upper limbs.…”