Long-Segment Epidural Hemorrhage of the Cervical and Dorsal Spine: A Case Report of a Rare Complication of Dengue Virus Disease

Dengue hemorrhagic fever is a severe form of dengue virus disease, characterized by minor to major bleeding, thrombocytopenia, and plasma leakage. Common hemorrhagic manifestations include epistaxis, gum bleeding, gastrointestinal bleeding, hypermenorrhea, and hematuria. Intracranial hemorrhage is one of the most fatal manifestations of central nervous system involvement by dengue disease which is a part of the expanded dengue syndrome. Here we present a case of A 37-year-old male patient who presented with complaints of intermittent high-grade fever and generalized weakness four days prior to consultation. Laboratory investigations revealed mild thrombocytopenia and positive dengue serology. Magnetic resonance imaging of the brain and spine revealed mild diffuse subarachnoid hemorrhage in bilateral parieto-occipital lobes with long segment cervical and dorsal spinal epidural hemorrhage.

Magnetic Resonance Imaging Scan of the Brain After Mild COVID-19 Infection

PURPOSE

There have been several reports of central nervous system impairments associated with severe coronavirus disease 2019 (COVID-19) infection on head magnetic resonance imaging and angiography (MRI/A). However, head MRI/A is rarely performed in mild cases, and there have been few reports on intracranial changes after COVID-19 infection in these cases. Here, we report a comparative examination of the findings seen in common head MRI/A sequences in mild cases of COVID-19.

METHODS

Of the 15,376 patients who underwent head MRI/A examination called "Brain Dock" between June 2020 and June 2021, 746 patients who received a COVID-19 antibody test were evaluated. Positive and negative patients were comparatively examined for head MRI/A findings such as cerebral white matter lesions, ischemic changes, cerebral microbleeds, cerebral aneurysms, arterial stenosis, sinusitis, and other abnormal findings.

RESULTS

Overall, 31 (4.2%) patients were COVID-19 positive, and all of them had mild infections not requiring hospitalization. There was no significant difference in patient characteristics and head MRI/A findings between positive and negative patients. All positive patients showed no particular abnormalities in the nasal findings such as olfactory bulb atrophy or thickening of the olfactory mucosa.

CONCLUSION

Intracranial lesions in mild patients do not show a clear difference from those in negative patients. This indicates that findings seen in common MRI/A sequences of severe patients are not likely in mild patients, supporting that there is relatively no damage to the central nervous system in mild patients.