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Cortical laminar necrosis in dengue encephalitis-a case report.
BMC Neurol. 2017 Apr 20; 17(1):79.BN

Abstract

BACKGROUND

Dengue encephalitis is a rare neurological manifestation of dengue fever. Its clinical presentation is similar to other viral encephalitides and encephalopathy. No single specific finding on magnetic resonance imaging of dengue encephalitis has yet been documented. They are highly variable and atypical.

CASE PRESENTATION

A 15-year boy presented with fever, the headache and altered sensorium of 12-day duration. On neurological examination, his Glasgow Coma Scale score was 10 (E3M4V3). There was no focal neurological deficit. Laboratory evaluation revealed leukopenia and marked thrombocytopenia. Dengue virus IgM antibody was positive both in serum and cerebrospinal fluid. Magnetic resonance imaging of the brain revealed signal changes in bilateral parietooccipital and left frontal regions (left hemisphere more involved than the right hemisphere). There was gyriform enhancement bilateral parietooccipital regions consistent with cortical laminar necrosis. Bilaterally diffuse subcortical white matter was also involved and subtle T2 hyperintensity involving both basal ganglia was noted. Gradient echo sequence revealed presence of hemorrhage in the subcortical white matter. Patient was treated conservatively and received platelet transfusion. Patient became fully conscious after 7 days.

CONCLUSION

In a patient with highly suggestive dengue e\ephalitis, we describe an unusual magnetic resonance imaging finding. This report is possibly the first instance of cortical laminar necrosis in such a setting.

Authors+Show Affiliations

Department of Neurology, King George's Medical University, UP, Lucknow, 226003, India. garg50@yahoo.com.Department of Neurology, King George's Medical University, UP, Lucknow, 226003, India.Department of Neurology, King George's Medical University, UP, Lucknow, 226003, India.Department of Microbiology, King George's Medical University, UP, Lucknow, 226003, India.Department of Neurology, King George's Medical University, UP, Lucknow, 226003, India.Department of Neurology, King George's Medical University, UP, Lucknow, 226003, India.Department of Neurology, King George's Medical University, UP, Lucknow, 226003, India.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28427358

Citation

Garg, Ravindra Kumar, et al. "Cortical Laminar Necrosis in Dengue Encephalitis-a Case Report." BMC Neurology, vol. 17, no. 1, 2017, p. 79.
Garg RK, Rizvi I, Ingole R, et al. Cortical laminar necrosis in dengue encephalitis-a case report. BMC Neurol. 2017;17(1):79.
Garg, R. K., Rizvi, I., Ingole, R., Jain, A., Malhotra, H. S., Kumar, N., & Batra, D. (2017). Cortical laminar necrosis in dengue encephalitis-a case report. BMC Neurology, 17(1), 79. https://doi.org/10.1186/s12883-017-0855-9
Garg RK, et al. Cortical Laminar Necrosis in Dengue Encephalitis-a Case Report. BMC Neurol. 2017 Apr 20;17(1):79. PubMed PMID: 28427358.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cortical laminar necrosis in dengue encephalitis-a case report. AU - Garg,Ravindra Kumar, AU - Rizvi,Imran, AU - Ingole,Rajan, AU - Jain,Amita, AU - Malhotra,Hardeep Singh, AU - Kumar,Neeraj, AU - Batra,Dhruv, Y1 - 2017/04/20/ PY - 2017/01/04/received PY - 2017/04/01/accepted PY - 2017/4/22/entrez PY - 2017/4/22/pubmed PY - 2017/9/19/medline KW - Case report KW - Cortical laminar necrosis KW - Dengue virus KW - Encephalitis KW - Encephalopathy KW - Magnetic resonance imaging SP - 79 EP - 79 JF - BMC neurology JO - BMC Neurol VL - 17 IS - 1 N2 - BACKGROUND: Dengue encephalitis is a rare neurological manifestation of dengue fever. Its clinical presentation is similar to other viral encephalitides and encephalopathy. No single specific finding on magnetic resonance imaging of dengue encephalitis has yet been documented. They are highly variable and atypical. CASE PRESENTATION: A 15-year boy presented with fever, the headache and altered sensorium of 12-day duration. On neurological examination, his Glasgow Coma Scale score was 10 (E3M4V3). There was no focal neurological deficit. Laboratory evaluation revealed leukopenia and marked thrombocytopenia. Dengue virus IgM antibody was positive both in serum and cerebrospinal fluid. Magnetic resonance imaging of the brain revealed signal changes in bilateral parietooccipital and left frontal regions (left hemisphere more involved than the right hemisphere). There was gyriform enhancement bilateral parietooccipital regions consistent with cortical laminar necrosis. Bilaterally diffuse subcortical white matter was also involved and subtle T2 hyperintensity involving both basal ganglia was noted. Gradient echo sequence revealed presence of hemorrhage in the subcortical white matter. Patient was treated conservatively and received platelet transfusion. Patient became fully conscious after 7 days. CONCLUSION: In a patient with highly suggestive dengue e\ephalitis, we describe an unusual magnetic resonance imaging finding. This report is possibly the first instance of cortical laminar necrosis in such a setting. SN - 1471-2377 UR - https://www.unboundmedicine.com/medline/citation/28427358/Cortical_laminar_necrosis_in_dengue_encephalitis_a_case_report_ L2 - https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-017-0855-9 DB - PRIME DP - Unbound Medicine ER -