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| LETTER TO EDITOR |
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| Year : 2013 | Volume
: 61
| Issue : 3 | Page : 317-318 |
Dengue infection presenting as ischemic stroke: An uncommon neurological manifestation
Rajesh Verma1, Ritesh Sahu1, Amit Shankar Singh2, Virendra Atam2
1 Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
2 Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| Date of Submission | 07-May-2013 |
| Date of Decision | 09-May-2013 |
| Date of Acceptance | 30-May-2013 |
| Date of Web Publication | 16-Jul-2013 |
Correspondence Address:
Rajesh Verma
Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.115083
How to cite this article:
Verma R, Sahu R, Singh AS, Atam V. Dengue infection presenting as ischemic stroke: An uncommon neurological manifestation. Neurol India 2013;61:317-8 |
Sir,
A 68-year-old man presented with moderate grade, continuous fever of 15 days duration and sudden onset weakness of left half of body with facial asymmetry, 10 days prior to admission. He had no skin rash or any other bleeding manifestation. He had no history of hypertension, diabetes mellitus or ischemic/valvular heart disease. On clinical examination, he was conscious and oriented, febrile with stable vitals and all peripheral pulses were well felt. Neurological examination revealed left upper motor neuron facial paresis, left motor hemiparesis (grade 1/5) with brisk deep tendon reflexes and an extensor left plantar response. Hemogram revealed leukocytosis with thrombocytopenia. Non-structural protein 1 antigen for dengue was positive in blood. Cerebrospinal fluid (CSF) study showed 15 cells (all lymphocytes) with normal protein and sugar level. ELISA test was positive for dengue specific immunoglobulin M antibody and non-reactive for varicella zoster, herpes simplex and Japanese encephalitis in serum and CSF. Magnetic resonance imaging of brain showed acute infarct in right parietal region [Figure 1]. 2D echocardiography and carotid doppler study were normal. He was treated conservatively and discharged on low dose aspirin 75 mg once a day and advised limb physiotherapy. Follow-up after 2 months showed partial improvement in limb weakness. | Figure 1: Magnetic resonance imaging brain axial T2‑flair (a) and diffusion weighted image (b) showing acute infarct in right fronto parietal region
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Dengue is the most common mosquito-borne viral disease worldwide. [1] In India, dengue has been endemic and in the recent years the reported frequency of outbreaks is high. Milder forms of dengue infection are asymptomatic, whereas the most severe forms manifesting as dengue shock syndrome with multi-organ failure. [2] Neurological complications of dengue infection include encephalitis, myelitis, Guillain-Barré syndrome and myositis. [3] Stroke in a patient with dengue is more often thrombocytopenia-related intracerebral hemorrhage. However, ischemic stroke as a complication of dengue infection has rarely been reported. [4],[5],[6] Seet and Lim reported a case of dysarthria clumsy hand syndrome in a patient with dengue infection. [6] One of the postulated pathogentic mechanism for ischemic stroke in dengue fever was meningovasculitis. [4] Another possible explanation may be a transient hypercoagulable state during dengue infection. Our patient did not have any other predisposing vascular risk factors for ischemic stroke except for the age. We presume that in this patient dengue infection is probably the cause for the ischemic stroke. Early supportive therapy in presence of dengue fever will help to improve the clinical outcome.
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| 1. | WHO. Dengue and dengue haemorrhagic fever. Factsheet N°117, revised March 2009. Geneva, World Health Organization, 2008. 
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| 2. | Narayanan M, Aravind MA, Thilothammal N, Prema R, Sargunam CS, Ramamurty N. Dengue fever epidemic in Chennai: A study of clinical profile and outcome. Indian Pediatr 2002;39:1027-33.
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| 3. | Verma R, Sharma P, Garg RK, Atam V, Singh MK, Mehrotra HS. Neurological complications of dengue fever: Experience from a tertiary center of north India. Ann Indian Acad Neurol 2011;14:272-8.
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| 4. | Liou LM, Lan SH, Lai CL. Dengue fever with ischemic stroke: A case report. Neurologist 2008;14:40-2.
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| 5. | Mathew S, Pandian JD. Stroke in patients with dengue. J Stroke Cerebrovasc Dis 2010;19:253-6.
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| 6. | Seet RC, Lim EC. Dysarthria-clumsy hand syndrome associated with dengue type-2 infection. J Neurol 2007;254:1129-30.
[PUBMED] |
[Figure 1]
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Pediatric Ischemic Stroke due to Dengue Vasculitis |
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| Subrat Kumar Nanda,Sita Jayalakshmi,Surath Mohandas | | Pediatric Neurology. 2014; 51(4): 570 | | [Pubmed] | [DOI] | |
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