Rao Sachin, Kumar Manish, Ghosh Soumik, Gadpayle Adesh Kumar
Department of Medicine, PGIMER Dr Ram Manohar Lohia Hospital, New Delhi, India.
BMJ Case Rep. 2013 Feb 13;2013:bcr2012008229. doi: 10.1136/bcr-2012-008229.
Dengue fever has a variable clinical spectrum ranging from asymptomatic infection to life-threatening dengue haemorrhagic fever and dengue shock syndrome. However, neurological complications, in general, are unusual. Dengue encephalopathy is not an unknown entity; however, dengue encephalitis, a direct neuronal infiltration by the dengue virus, is an extremely rare disease. Although dengue is classically considered a non-neurotropic virus, there is increasing evidence for dengue viral neurotropism, suggesting that, in a proportion of cases, there may be an element of direct viral encephalitis. An MRI brain rarely shows focal abnormalities in dengue encephalitis. We report an interesting case of dengue encephalitis during an outbreak in Delhi, India. The diagnosis was confirmed by blood and cerebrospinal fluid dengue serology and (NS1) antigen assay. The case showed extensive lesions involving the midbrain, cerebellum, thalamus and medial temporal region on both sides of the MRI brain, which is an uncommon manifestation of dengue fever.
登革热具有多样的临床谱，范围从无症状感染到危及生命的登革出血热和登革休克综合征。然而，一般来说，神经并发症并不常见。登革热脑病并非未知疾病；然而，登革热脑炎，即登革病毒对神经元的直接浸润，是一种极为罕见的疾病。尽管登革热传统上被认为是一种非嗜神经性病毒，但越来越多的证据表明登革病毒具有嗜神经性，这表明在一部分病例中，可能存在直接病毒性脑炎的因素。登革热脑炎患者的脑部磁共振成像（MRI）很少显示局灶性异常。我们报告了印度德里一次疫情期间一例有趣的登革热脑炎病例。通过血液和脑脊液登革热血清学及（NS1）抗原检测确诊。该病例在脑部MRI上显示广泛病变累及中脑、小脑、丘脑和双侧内侧颞叶区域，这是登革热的一种不常见表现。
