Teaching NeuroImages: Bilateral intracerebral hemorrhage in expanded dengue syndrome

A 66-year-old Brazilian woman presented with fever, malaise, and myalgia, followed 10 days later by left hemiparesis and altered mental status. Brain MRI revealed bilateral intracerebral hemorrhages (figure, A and B) and CSF showed mild lymphocytic pleocytosis. Serologic testing for dengue fever was positive. Brain biopsy demonstrated nonspecific inflammatory changes and areas of recent hemorrhage and necrosis (figure, C). After 1 month, partial clinical and radiologic improvement occurred (figure, D). Expanded dengue syndrome1 refers to atypical manifestations of dengue such as intracerebral hemorrhage, which is a rare presentation usually reported a week after fever onset, possibly related to release of cytokines with vasogenic activity.2

Source: Neurology - July 31, 2017 Category: Neurology Authors: Palmeira Cavalcante, W. C., Neto, H. R. S., Grativvol, R. S., Spera, R. R., Frassetto, F. P., Lucato, L. T., Nitrini, R. Tags: MRI, Viral infections, Intracerebral hemorrhage RESIDENT AND FELLOW SECTION Source Type: research