Journal of Global Infectious DiseasesOfficial Publishing of INDUSEM and OPUS 12 Foundation, Inc. Users online:518  
Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size     
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 

   Table of Contents     
Year : 2011  |  Volume : 3  |  Issue : 2  |  Page : 206-207
A case of dengue encephalitis with intracerebral hemorrhage

Department of Medicine, Chhattarpati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

Click here for correspondence address and email

Date of Web Publication27-May-2011

How to cite this article:
Khanna A, Atam V, Gupta A. A case of dengue encephalitis with intracerebral hemorrhage. J Global Infect Dis 2011;3:206-7

How to cite this URL:
Khanna A, Atam V, Gupta A. A case of dengue encephalitis with intracerebral hemorrhage. J Global Infect Dis [serial online] 2011 [cited 2022 May 25];3:206-7. Available from:


Dengue fever has varying clinical presentations, ranging from asymptomatic infection to dengue shock syndrome. [1] Neurological complications, in general, are unusual; however, sporadic cases have been reported, world over. [2] We report here a case of a patient of dengue encephalitis who also developed left-sided hemiparesis, secondary to intracerebral bleed as a result of profound thrombocytopenia.

A previously healthy 28-year-old male farmer presented with high-grade fever for the preceding six days, followed by generalized tonic-clonic seizures and altered sensorium for two days. Clinical examination revealed stable vital parameters and a diffuse erythematous macular rash on trunk and legs. Neurological examination revealed a Glasgow Coma Scale (GCS) of 8, absent neck rigidity and Kernig sign. Pupillary size and reaction were normal, with bilateral extensor plantars. Investigations revealed a hemoglobin of 9 gm%, total leukocyte count of 2,300/mm [3] with normal differentials and morphology; platelet count on admission was 30,000/mm. [3] Serum electrolytes and results of renal and liver function tests were normal. Malarial parasite was undetectable in the peripheral blood smear, and rapid card test for malarial parasite(MP) was negative. Cerebrospinal fluid (CSF) analysis (done after transfusion of 3units of platelets; pre-lumbar puncture platelet count, 62,000/mm 3 ) showed an elevated opening pressure; clear appearance; 60 cells, all being lymphocytes. Protein was 68mg/dL; and sugar, 80mg/dL. MRI brain was suggestive of diffuse cerebral edema.

The clinico-pathological picture prompted us to make a working diagnosis of acute viral encephalitis, and accordingly the patient was analyzed for serum and CSF using ELISA for Japanese encephalitis (Xcyton, Bengaluru, India) and Herpes Simplex Virus 1HSV-1 (Disse Diagnostics, Italy), both being more common causes of viral encephalitis in our setting. Both were found to be negative in serum and CSF. Paired sera were positive for IgM dengue (IgM capture ELISA for dengue by NIV, Pune, India); and NS-1 antigen (J. Mitra and Company) was found to be positive. CSF also tested positive for IgM dengue. Blood and CSF cultures were negative. X-ray chest revealed bilateral pleural effusion. CSF-PCR (polymerase chain reaction) for dengue could not be done.

After initial improvement for two days, the general condition of the patient worsened, and he developed bleeding from the IV cannula site and the urinary catheter. Platelet count at this time was 5,000/mm 3 . [3] The patient was given 2units of packed red blood cells and 5units of platelets. Clinical examination revealed preferential movement of the right side of the body and the left plantar was extensor. MRI brain was repeated, and it revealed an intracerebral bleed in the right basal ganglia region with intraventricular extension. The coagulation profile was normal. The patient was transfused 4 more units of platelets and fresh frozen plasma. Repeat platelet count the next day was 6,000/mm 3 . [3] The patient was managed conservatively with general supportive measures. The patient expired on the 10 th day after admission.

On reviewing available literature, the entity of dengue encephalitis with thrombocytopenia-induced intracerebral bleeding has not been reported. The neurovirulent properties of dengue are not well known. CNS involvement with dengue has been reported in the form of seizures, meningitis, encephalitis, etc. [3] This documentation is presented because of a rare manifestation of a common disease, and it also highlights an important, potentially fatal complication of this disease.

   References Top

1.Koley TK, Jain S, Sharma H, Kumar S, Mishra S, Gupta MD, et al. Dengue encephalitis. J Assoc Physicians India 2003;51: 422-3.  Back to cited text no. 1
2.Mehendale SM, Rodringues FM, Pinto BD. A sporadic case of dengue encephalopathy. J Assoc Physicians India 1989;37:346.  Back to cited text no. 2
3.Thisyakorn U, Thisyakorn C, Limpitkul W, Nisalak A. Dengue infection with cerebral nervous system manifestations. Southeast Asian J Trop Med Public Health 1999;30:504-6.  Back to cited text no. 3

Correspondence Address:
Arjun Khanna
Department of Medicine, Chhattarpati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-777X.81707

Rights and Permissions

This article has been cited by
Showkat Nazir Wani, Anish Garg Atul Kaushik, Atul Kaushik, Naveen Tariq
[Pubmed] | [DOI]
2 Cerebellar Hemorrhage in a Patient during the Convalescent Phase of Dengue Fever
Ángel Vargas-Sánchez,Erwin Chiquete,Patricia Gutiérrez-Plascencia,Víctor Castañeda-Moreno,Denisse Alfaro-Castellanos,Patricia Paredes-Casillas,José L. Ruiz-Sandovala
Journal of Stroke. 2014; 16(3): 202
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


 Article Access Statistics
    PDF Downloaded36    
    Comments [Add]    
    Cited by others 2    

Recommend this journal

Sitemap | What's New | Feedback | Copyright and Disclaimer | Privacy Notice | Contact Us
© 2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008