Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 58, Num. 6, 2010, pp. 962-963

Neurology India, Vol. 58, No. 6, November-December, 2010, pp. 962-963

Letter to Editor

Paraplegia in a patient with dengue

Preeti Singh¹, Bushan Joseph²

¹ Department of Neurology, HOSMAT Hospital, Magrath Road, Bangalore, India
² Department of Neurosurgery, HOSMAT Hospital, Magrath Road, Bangalore, India
Correspondence Address: Preeti Singh, Department of Neurology, HOSMAT Hospital, Magrath Road, Bangalore, India, preetis5@hotmail.com

Date of Acceptance: 06-Nov-2010

Code Number: ni10273

PMID: 21150075
DOI: 10.4103/0028-3886.73770

Sir,

Dengue fever caused by the Flavi virus is a common viral infection in the Indian subcontinent. A neurological complication occurs in about 0.5 to 6% of the cases, ^[1] and is the subject of several reviews. ^[2],[3] Thrombocytopenia is a common feature in dengue fever. We report an unusual cause of paraplegia in dengue, thrombocytopenia-associated epidural hematoma.

A 53-year-old female had high grade fever associated with intense tiredness and vomiting. The initial platelet count was 52,000 per microliter. The bleeding and clotting parameters were normal. Two days later she developed low back pain and leg pains that progressed to weakness of both the lower limbs and retention of urine over the next two days. There were no symptoms in the upper limbs, cranial nerve or visual symptoms. She was a known diabetic and hypertensive since 10 years. There was no history of recent vaccinations or dog bite. On admission to this facility she was afebrile and normotensive. There were no petechiae or purpura. The heart and lung examination was normal and there was no organomegaly. On neurological examination she was conscious and well-oriented. Ocular fundi, cranial nerves, and upper limb examination was essentially normal. Motor power in both the lower limbs was 0/5 with areflexia and upgoing plantar response. She had sensory loss for all the modalities below the T10 segment. A diagnosis of transverse myelitis was suspected and she was started on intravenous methyl prednisolone 1 gm/day. Magnetic resonance imaging (MRI) of the spine revealed an epidural mass with cord compression at T8 - T10 [Figure - 1]. She underwent laminectomy and evacuation of a large epidural clot [Figure - 2] and [Figure - 3]. She remained paraplegic (motor power 0/5) postoperatively. Intravenous methylprednisolone was continued for a further five days empirically, with no recovery. Dengue serology done by the Elisa technique was positive for Ig M.

The epidural hematoma in this patient was presumed to be related to dengue-associated thrombocytopenia and vasculopathy. ^[3] This is probably the first such complication documented in dengue fever, in the literature. ^[2],[3]

References

1.	Hendarto SK, Hadinegoro SR. Dengue encephalopathy. Acta Paediatr Jpn 1992;34:350-7.  Back to cited text no. 1  [PUBMED]
2.	Mishra UK, Kalita J. Spectrum of neurological manifestation of dengue in India. Dengue Bull 2006;30:107-13.  Back to cited text no. 2
3.	Murthy JM. Neurological complications of dengue infection. Neurol India 2010;58:581-4.   Back to cited text no. 3  [PUBMED]

Copyright 2010 - Neurology India

The following images related to this document are available:

Photo images