Pandeya A, Upadhyay D, Oli B, Parajuli M, Silwal N, Shrestha A, Gautam N, Gajurel BP. Dengue encephalitis featuring “double-doughnut” sign - A case report.
Ann Med Surg (Lond) 2022;
78:103939. [PMID:
35734672 PMCID:
PMC9207141 DOI:
10.1016/j.amsu.2022.103939]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction
Dengue is a common febrile illness caused by Dengue virus and spread by Aedes mosquitoes. The neurological complications like encephalopathy or encephalitis or immune-mediated neurological syndromes are uncommon though. Discrete neuroimaging findings in this setting are even rarer. We report a case of dengue encephalitis with uncommon MRI features in a young female.
Case presentation
The patient presented with complains of fever, vomiting, weakness in all limbs and difficulty in speech. Neurological examination revealed bilateral horizontal gaze palsy with impaired oculo-cephalic reflex, bulbar dysarthria and quadriplegia with bilateral planters up-going. Laboratory reported anemia, thrombocytopenia and positive NS1 antigen while excluding other tropical and immunological diseases. Brain MRI revealed extensive thalamic involvement as unique “double-doughnut” sign along with lesions in brainstem. The patient received supportive treatment in intensive unit and was discharged following improvement in clinical condition and laboratory reports.
Clinical discussion
Dengue can infect the central nervous system directly as encephalitis or can have neurological consequences following multi-organ dysfunction and shock as encephalopathy or post-infection immunological syndromes as Guillain-Barré Syndrome or cerebrovascular complications or dengue muscle dysfunction. The MRI appearance of “double-doughnut” sign points towards dengue encephalitis in appropriate setting.
Conclusion
A high index of suspicion is required to make a diagnosis of dengue encephalitis. The “double-doughnut” sign in MRI sequences has the potential to become a diagnostic marker for dengue encephalitis.
Dengue encephalitis is an uncommon complication of dengue infection.
The extensive lesions and unique “double-doughnut” sign in MRI are even rarer.
The sign has a potential to become a diagnostic marker in an appropriate setting.
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