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. 2017 Oct-Dec;12(4):804. doi: 10.4103/ajns.AJNS_66_14

Intracranial Hemorrhage in Dengue: Where Is It?

Viroj Wiwanitkit 1,2,3,4,
PMCID: PMC5652130  PMID: 29114318

Sir,

Dengue is a problematic infectious disease which can be seen worldwide. Acute febrile illness accompanying with bleeding tendency is the main clinical picture of dengue.[1,2] However, dengue can have other clinical features including to neurological deterioration. Due to the bleeding tendency in dengue, intracranial bleeding is rate but important complication of dengue. There are limited reports on the nature of this dengue complication. Here, the author tried to summarize previous report on this problem and this to answer the question on what the most common site of intracranial hemorrhage due to dengue is. Based on available data on 19 cases from 15 publications, the site of bleedings includes cerebellum (one case),[3] pons (two cases),[4,5] pituitary (two cases),[6,7] subdural space (three cases),[8,9,10] cerebrum (five cases),[4,5,11,12,13] and subarachnoid space (six cases).[14,15,16,17] Based on this small data, subarachnoid is the most common site of hemorrhage following by cerebrum.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  • 1.Wiwanitkit V. Dengue fever: Diagnosis and treatment. Expert Rev Anti Infect Ther. 2010;8:841–5. doi: 10.1586/eri.10.53. [DOI] [PubMed] [Google Scholar]
  • 2.Wiwanitkit V. Bleeding and other presentations in Thai patients with dengue infection. Clin Appl Thromb Hemost. 2004;10:397–8. doi: 10.1177/107602960401000414. [DOI] [PubMed] [Google Scholar]
  • 3.Singh M, Garg K, Bisht A, Sharma BS, Singh PK, Pandia M, et al. Spinal epidural hematoma with myelitis and brainstem hemorrhage: An unusual complication of dengue fever. Neurol India. 2013;61:541–3. doi: 10.4103/0028-3886.121946. [DOI] [PubMed] [Google Scholar]
  • 4.Kumar J, Kumar A, Gupta S, Jain D. Neurological picture. Dengue haemorrhagic fever: An unusual cause of intracranial haemorrhage. J Neurol Neurosurg Psychiatry. 2007;78:253. doi: 10.1136/jnnp.2006.100909. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Mathew S, Pandian JD. Stroke in patients with dengue. J Stroke Cerebrovasc Dis. 2010;19:253–6. doi: 10.1016/j.jstrokecerebrovasdis.2009.05.003. [DOI] [PubMed] [Google Scholar]
  • 6.Wildemberg LE, Neto LV, Niemeyer P, Gasparetto EL, Chimelli L, Gadelha MR. Association of dengue hemorrhagic fever with multiple risk factors for pituitary apoplexy. Endocr Pract. 2012;18:e97–101. doi: 10.4158/EP11341.CR. [DOI] [PubMed] [Google Scholar]
  • 7.Kumar V, Kataria R, Mehta VS. Dengue hemorrhagic fever: A rare cause of pituitary tumor hemorrhage and reversible vision loss. Indian J Ophthalmol. 2011;59:311–2. doi: 10.4103/0301-4738.82002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Jain N, Gutch M, Kumar V, Naik AK. A fatal combo of dengue shock syndrome with acute subdural hematoma. Neurol India. 2012;60:105–6. doi: 10.4103/0028-3886.91383. [DOI] [PubMed] [Google Scholar]
  • 9.Mittal M, Jain N. Subdural haematoma and axonal polyneuropathy complicating dengue fever. BMJ Case Rep 2011. 2011 doi: 10.1136/bcr.12.2010.3672. pii: Bcr1220103672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Kumar R, Prakash O, Sharma BS. Dengue hemorrhagic fever: A rare presentation as atypical acute subdural hematoma. Pediatr Neurosurg. 2008;44:490–2. doi: 10.1159/000180305. [DOI] [PubMed] [Google Scholar]
  • 11.Assir MZ, Jawa A, Ahmed HI. Expanded dengue syndrome: Subacute thyroiditis and intracerebral hemorrhage. BMC Infect Dis. 2012;12:240. doi: 10.1186/1471-2334-12-240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Wafa SR, Jamsari S, Karis BM. A case report: Intracranial haemorrhage in a patient with probable dengue fever. Med J Malaysia. 1999;54:273–6. [PubMed] [Google Scholar]
  • 13.de Souza LJ, Martins AL, Paravidini PC, Nogueira RM, Gicovate Neto C, Bastos DA, et al. Hemorrhagic encephalopathy in dengue shock syndrome: A case report. Braz J Infect Dis. 2005;9:257–61. doi: 10.1590/s1413-86702005000300009. [DOI] [PubMed] [Google Scholar]
  • 14.Jensenius M, Berild D, Ormaasen V, Maehlen J, Lindegren G, Falk KI. Fatal subarachnoidal haemorrhage in a Norwegian traveller with dengue virus infection. Scand J Infect Dis. 2007;39:272–4. doi: 10.1080/00365540600891307. [DOI] [PubMed] [Google Scholar]
  • 15.Sanjay S, Au Eong KG. Bilateral vitreous haemorrhage associated with dengue fever. Eye (Lond) 2007;21:144–5. doi: 10.1038/sj.eye.6702471. [DOI] [PubMed] [Google Scholar]
  • 16.Jayasinghe NS, Thalagala E, Wattegama M, Thirumavalavan K. Dengue fever with diffuse cerebral hemorrhages, subdural hematoma and cranial diabetes insipidus. BMC Res Notes. 2016;9:265. doi: 10.1186/s13104-016-2068-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Patey O, Ollivaud L, Breuil J, Lafaix C. Unusual neurologic manifestations occurring during dengue fever infection. Am J Trop Med Hyg. 1993;48:793–802. doi: 10.4269/ajtmh.1993.48.793. [DOI] [PubMed] [Google Scholar]

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