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Dengue fever with diffuse cerebral hemorrhages, subdural hematoma and cranial diabetes insipidus.

Jayasinghe NS, Thalagala E, Wattegama M, Thirumavalavan K - BMC Res Notes (2016)

Bottom Line: Dengue was confirmed serologically.Exact pathophysiological mechanism of diffuse cerebral haemorrhages without profound thrombocytopenia is not well understood.However further comprehensive research and studies are needed to understand the pathophysiological mechanisms leading to this complication.

View Article: PubMed Central - PubMed

Affiliation: General Medical Unit, National Hospital of Sri Lanka, Colombo, Western Province, Sri Lanka. shermi17@gmail.com.

ABSTRACT

Background: Neurological manifestations in dengue fever occur in <1 % of the patients and known to be due to multisystem dysfunction secondary to vascular leakage. Occurrence of wide spread cerebral haemorrhages with subdural hematoma during the leakage phase without profound thrombocytopenia and occurrence of cranial diabetes insipidus are extremely rare and had not been reported in published literature earlier, thus we report the first case.

Case presentation: A 24 year old previously healthy lady was admitted on third day of fever with thrombocytopenia. Critical phase started on fifth day with evidence of pleural effusion and moderate ascites. Thirty one hours into critical phase she developed headache, altered level of consciousness, limb rigidity and respiratory depression without definite seizures. Non-contrast CT brain done at tertiary care level revealed diffuse intracranial haemorrhages and sub arachnoid haemorrhages in right frontal, parietal, occipital lobes and brainstem, cerebral oedema with an acute subdural hematoma in right temporo- parietal region. Her platelet count was 40,000 at this time with signs of vascular leakage. She was intubated and ventilated with supportive care. Later on she developed features of cranial diabetes insipidus and it responded to intranasal desmopressin therapy. In spite of above measures signs of brainstem herniation developed and she succumbed to the illness on day 8. Dengue was confirmed serologically.

Conclusions: Exact pathophysiological mechanism of diffuse cerebral haemorrhages without profound thrombocytopenia is not well understood. Increased awareness and high degree of clinical suspicion is needed among clinicians for timely diagnosis of this extremely rare complication of dengue fever. We postulate that immunological mechanisms may play a role in pathogenesis. However further comprehensive research and studies are needed to understand the pathophysiological mechanisms leading to this complication.

No MeSH data available.


Related in: MedlinePlus

a, b Non contrast computer tomography (CT) brain showing right frontal, left parietal and occipital lobe subarachnoid hemorrhages and intra cranial hemorrhages. c, d Non contrast computer tomography (CT) brain showing right subdural hematoma
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Fig1: a, b Non contrast computer tomography (CT) brain showing right frontal, left parietal and occipital lobe subarachnoid hemorrhages and intra cranial hemorrhages. c, d Non contrast computer tomography (CT) brain showing right subdural hematoma

Mentions: Urgent non contrast computer tomography (CT) of brain showed multiple sub arachnoid hemorrhages in right frontal, left parietal and occipital lobes. It also showed right sided sub dural hematoma and gross cerebral edema compressing bilateral lateral ventricles, third ventricle and brainstem. (As reported by consultant radiologist) (Fig. 1).Fig. 1


Dengue fever with diffuse cerebral hemorrhages, subdural hematoma and cranial diabetes insipidus.

Jayasinghe NS, Thalagala E, Wattegama M, Thirumavalavan K - BMC Res Notes (2016)

a, b Non contrast computer tomography (CT) brain showing right frontal, left parietal and occipital lobe subarachnoid hemorrhages and intra cranial hemorrhages. c, d Non contrast computer tomography (CT) brain showing right subdural hematoma
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4862122&req=5

Fig1: a, b Non contrast computer tomography (CT) brain showing right frontal, left parietal and occipital lobe subarachnoid hemorrhages and intra cranial hemorrhages. c, d Non contrast computer tomography (CT) brain showing right subdural hematoma
Mentions: Urgent non contrast computer tomography (CT) of brain showed multiple sub arachnoid hemorrhages in right frontal, left parietal and occipital lobes. It also showed right sided sub dural hematoma and gross cerebral edema compressing bilateral lateral ventricles, third ventricle and brainstem. (As reported by consultant radiologist) (Fig. 1).Fig. 1

Bottom Line: Dengue was confirmed serologically.Exact pathophysiological mechanism of diffuse cerebral haemorrhages without profound thrombocytopenia is not well understood.However further comprehensive research and studies are needed to understand the pathophysiological mechanisms leading to this complication.

View Article: PubMed Central - PubMed

Affiliation: General Medical Unit, National Hospital of Sri Lanka, Colombo, Western Province, Sri Lanka. shermi17@gmail.com.

ABSTRACT

Background: Neurological manifestations in dengue fever occur in <1 % of the patients and known to be due to multisystem dysfunction secondary to vascular leakage. Occurrence of wide spread cerebral haemorrhages with subdural hematoma during the leakage phase without profound thrombocytopenia and occurrence of cranial diabetes insipidus are extremely rare and had not been reported in published literature earlier, thus we report the first case.

Case presentation: A 24 year old previously healthy lady was admitted on third day of fever with thrombocytopenia. Critical phase started on fifth day with evidence of pleural effusion and moderate ascites. Thirty one hours into critical phase she developed headache, altered level of consciousness, limb rigidity and respiratory depression without definite seizures. Non-contrast CT brain done at tertiary care level revealed diffuse intracranial haemorrhages and sub arachnoid haemorrhages in right frontal, parietal, occipital lobes and brainstem, cerebral oedema with an acute subdural hematoma in right temporo- parietal region. Her platelet count was 40,000 at this time with signs of vascular leakage. She was intubated and ventilated with supportive care. Later on she developed features of cranial diabetes insipidus and it responded to intranasal desmopressin therapy. In spite of above measures signs of brainstem herniation developed and she succumbed to the illness on day 8. Dengue was confirmed serologically.

Conclusions: Exact pathophysiological mechanism of diffuse cerebral haemorrhages without profound thrombocytopenia is not well understood. Increased awareness and high degree of clinical suspicion is needed among clinicians for timely diagnosis of this extremely rare complication of dengue fever. We postulate that immunological mechanisms may play a role in pathogenesis. However further comprehensive research and studies are needed to understand the pathophysiological mechanisms leading to this complication.

No MeSH data available.


Related in: MedlinePlus