Brivazens
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 1001  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
  »  Article in PDF (783 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  References
 »  Article Figures

 Article Access Statistics
    Viewed10050    
    Printed131    
    Emailed0    
    PDF Downloaded209    
    Comments [Add]    
    Cited by others 3    

Recommend this journal

 


 
Table of Contents    
NEUROIMAGES
Year : 2017  |  Volume : 65  |  Issue : 3  |  Page : 670-671

Dengue encephalitis: “Double doughnut” sign


1 Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication9-May-2017

Correspondence Address:
Sahil Mehta
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/neuroindia.NI_723_16

Rights and Permissions



How to cite this article:
Kumar AS, Mehta S, Singh P, Lal V. Dengue encephalitis: “Double doughnut” sign. Neurol India 2017;65:670-1

How to cite this URL:
Kumar AS, Mehta S, Singh P, Lal V. Dengue encephalitis: “Double doughnut” sign. Neurol India [serial online] 2017 [cited 2023 Sep 26];65:670-1. Available from: https://www.neurologyindia.com/text.asp?2017/65/3/670/205939


A 22-year old primigravida presented with a 10-day history of fever and altered sensorium of 3-day duration. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis with elevated protein (316 mg/dl) and normal sugar (76 mg/dl). IgG/IgM antibodies against dengue viral infections were positive in the serum and negative in CSF. IgM antibodies for Leptospira and Japanese encephalitis were negative. Magnetic resonance imaging (MRI) showed extensive parenchymal lesions in the bilateral thalami, midbrain, and deep cerebellar white matter. The lesions in bilateral thalami were hypointense on T1-weighted and hyperintense on T2 and fluid-attenuated inversion recovery (FLAIR); centre of the lesions showed intense diffusion restriction with presence of hemorrhage on susceptibility weighted images giving the appearance of double doughnut sign [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e.
Figure 1: MRI brain (a). Hypointensity in bilateral thalami in T1W images (b). Hyperintensity in bilateral thalami in T2W images (c and d). Intense diffusion restriction at the centre of bilateral thalami in DW and ADC images (e) with hemorrhages in the centre of bilateral thalami in SWI

Click here to view


Diagnosis of dengue encephalitis was made based on criteria laid down by Soares et al.[1]

  1. Presence of fever;
  2. Acute signs of cerebral involvement such as altered consciousness or personality and/or seizures and/or focal neurological signs;
  3. Reactive IgM dengue antibody, NS1 antigen, or positive dengue polymerase chain reaction in serum and/or CSF;
  4. Exclusion of other causes of viral encephalitis and encephalopathy.


Thalamic involvement has been described in dengue encephalitis; however, to the best of our knowledge, this kind of appearance has not been reported in literature.[2],[3],[4],[5] Other imaging findings include involvement of brainstem, cerebellum, and medial temporal lobes. We propose to name the MRI finding in dengue encephalitis as “double doughnut sign.”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Soares CN, Marzia PS. Diagnosis criteria of dengue encephalitis. Arq Neuropsiquiatr 2014:72:263.  Back to cited text no. 1
    
2.
Borawake K, Prayag P, Wagh A, Dole S. Dengue encephalitis. Indian J Crit Care Med 2011;15:190-3.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Kamble R, Peruvamba JN, Kovoor J, Ravishankar S, Kolar BS. Bilateral thalamic involvement in dengue infection. Neurol India 2007;55:418-9.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Varatharaj A. Encephalitis in the clinical spectrum of dengue infection. Neurol India 2010;58:585-91.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Garg RK, Malhotra HS, Jain A, Malhotra KP. Dengue-associated neuromuscular complications. Neurol India 2015;63:497-16.  Back to cited text no. 5
[PUBMED]  [Full text]  


    Figures

  [Figure 1]

This article has been cited by
1 Dengue encephalitis featuring “double-doughnut” sign - A case report
Anupama Pandeya, Devansh Upadhyay, Bikram Oli, Monika Parajuli, Nitesh Silwal, Aashish Shrestha, Niraj Gautam, Bikram Prasad Gajurel
Annals of Medicine and Surgery. 2022; 78: 103939
[Pubmed] | [DOI]
2 A systematic review of brain imaging findings in neurological infection with Japanese encephalitis virus compared with Dengue virus
Thomas Pichl, Catherine J Wedderburn, Chandrashekar Hoskote, Lance Turtle, Tehmina Bharucha
International Journal of Infectious Diseases. 2022; 119: 102
[Pubmed] | [DOI]
3 The Spectrum of MRI Findings in Dengue Encephalitis
Priyal LNU, Vineet Sehgal, Lucky Bhalla Sehgal, Nihal Gulati, Saniya Kapila
Cureus. 2022;
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow