Clinico-Radiological Profile and Outcome of Dengue Patients with Neurological Manifestations- A Cross-Sectional Study

Abstract

Introduction: Dengue fever is an endemic infection in India and is a major public health problem. The expanded dengue syndrome incorporates rare and unusual manifestations affecting other organ systems like the CNS, respiratory, hepatic and gastrointestinal systems. The neurological complications of dengue fever can be broadly classified as Dengue viral encephalitis, Dengue viral encephalopathy, immune mediated syndrome which includes acute disseminated encephalomyelitis, and dengue associated stroke.

Aim: To evaluate the clinico- radiological profile and outcome of serologically confirmed dengue patients having varied manifestations of central nervous system involvement.

Materials and methods: This descriptive cross-sectional study was done at the Department of Paediatrics, and Department of Neurology, Sree Balaji Medical College & Hospital, Chennai from January 2021 to January 2022. The total 562 children of dengue fever were studied within the study duration and out of these 11 children with neurological complications were subjected to a detailed clinical evaluation, laboratory assessment, CSF study, EEG and neuroimaging. The summary of the statistical analysis is presented as frequencies and percentages.

Results: During the study period out of the total of 562 children with dengue 11 (1.9%) had neurological manifestations.The mean age of the children with neurological complications was 6.8 +/- 3.88 years. The male: female ratio was 1.75:1. Most common neurological manifestation was acute encephalitic syndrome (AES) seen in 7 patients (63.6%) out of the 11 children. MRI done for severe headache following second week of fever showed severe manifestations like thalamus infarct, and cerebral hemorrhage with mass effect. Headache following first week of fever showed mild manifestations like ADEM, and double doughnut sign in MRI.

Conclusion In the present study, the prevalence of neurological symptoms among children with dengue fever were found as 1.9%. It was also observed that new onset headache occurring in the second week following dengue fever is a warning sign for severe CNS disease.