Acute disseminated encephalomyelitis after dengue

Abstract

Dengue fever, transmitted by Aedes aegypti mosquitoes, is one of the most common vector-borne disease. Its incidence is increasing steadily worldwide, becoming a major public health problem in the tropical and subtropical zone. Neurological manifestations after dengue are not very common and acute disseminated encephalomyelitis (ADEM) following dengue infections is rare with a few cases documented in literature. Clinical characteristics and typical lesions of ADEM on magnetic resonance imaging (MRI) of brain along with serologic positivity for dengue usually confirm the diagnosis. We report a case of ADEM which developed as a neurological complication of dengue during an epidemic in a 39-year-old woman.

Keywords: ADEM, Acute Disseminated Encephalomyelitis; Acute disseminated encephalomyelitis; CSF, Cerebrospinal Fluid; Dengue infection; EEG, Electroencephalography; MRI, Magnetic Resonance Imaging; Mayotte; PCR, Polymerase Chain Reaction.

Fig. 1

A. FLAIR axial section showing the diffuse involvement of the corpus callosum (red arrowhead), the corona radiata (red star), left subcortical cortical white matter and middle cerebellar peduncles with predominant involvement on the left (white arrowhead) associated with a hypersignal of the anterior part of the medullary bulb (red circle).B. Axial T1 SE GADO showing nodular contrast enhancement of the corpus callosum (white star). C. Diffusion b 1000 with adc mapping showing bilateral and symmetrical capsulo-lenticular hypersignal and unrestricted corpus callosplenum splenium on adc mapping (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.).

Fig. 2

A- T2 TSE sagittal section showing diffuse myelitis lesions in hypersignal T2 TSE (white star).B. T1 TSE sagittal section after injection of gadolinium showing multifocal centromedullary and posterior cervical and dorsal stage contrast enhancement (white arrowhead).C. FFE axial 3D T1-weighted image after injection showing an increase in contrast enhancement of the corpus callosum and subcortical right parietal white matter (red star) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.).