Acute Subdural Hematoma in a Patient with Dengue – Case Report and Review of Literature

Aim and ObjectiveDengue fever is the most important arboviral infection in the world, with an estimated 100 million cases per year and 2.5 billion people at risk. Intra-cranial hemorrhage is a rare complication of dengue virus infection. We present a case report of a young male diagnosed to have dengue infection with low platelet count who presented to us with intracranial bleed. The CTScan brain plain picture resembled that of an (Fig 1) intracerebral hematoma. He was worked up to look for other causes of intracerebral bleed, CT Angiogram donedid not suggest any feature of vascular malformation but the clot appeared to be extradural. (Fig 2 a,b). He underwent surgery and the clot was found to be subdural in location. He was transfused platelet on cell separator, pre and postoperatively. He showed neurological improvement after surgery and was discharged without any neurological squeale. We review the literature of neurological involvement in dengue fever.Clinical PresentationA 29 years old, right handed male presented with fever of one week duration, headache, vomiting and altered sensorium since a day. On examination he had bradycardia, pulse- 56/min. Pupils were equal and reacting. He was opening eyes to call, producing incomprehensible sound and localizing briskly with right upper limb. He had left upper motor neuron facial palsy with left hemiparesis of grade 3. Left plantar was extensor in response. During investigation he was found to have thrombocytopenia. Dengue serology was reactive. His liver function was slightly deranged. He was evaluated with CT angiogram of brain showed right parietal extra-cerebral collection and ruled out the possibility of vascular malformation.InterventionHe underwent right parietal craniotomy and evacuation of the subdural hematoma.ConclusionIntracranial hemorrhage is a rare complication of dengue fever. Other causes of encephalopathy are cerebral edema, hyponatremia, cerebral anoxia, fulminant hepatic failure with portosystemic encephalopathy, microcapillary hemorrhage. We report a rare case of acute subdural hematoma as a presenting feature of dengue fever.