Acute disseminated encephalomyelitis in classic dengue Encefalomielite disseminada aguda em dengue clássica

Neurological manifestation is uncommon in dengue infection. The pathogenesis of central nervous system involvement is controversial. We report a rare case of acute disseminated encephalomyelitis in classic dengue, with isolation of serotype 3 in liquor. This condition was associated with significant structural damage detected by magnetic resonance. Key-words: Acute disseminated encephalomyelitis. Dengue. Neurological symptoms. ReSuMo Manifestação neurológica é incomum em dengue. A patogênese do acometimento do sistema nervosa central é controversa. Nós relatamos um raro caso de encefalomielite disseminada aguda em dengue clássica, com isolamento do sorotipo 3 em líquor. O quadro estava associado a significativo dano estrutural detectado pela ressonância magnética. Palavras-chaves: Encefalite disseminada aguda. Dengue. Manifestações neurológicas. her symptoms started, she had difficulty in pronouncing some words, and this evolved to progressive impairment in spontaneous speech. She presented weakness in the left hand, which was most pronounced in the first and second fingers. This made the use of tweezers difficult, thereby compromising her professional activity (dentist). She had a sensation of heaviness in her left leg, with repercussions on her gait, and this was the principal preoccupation leading to consultation with a neurologist. The initial neurological examination showed speech disturbances characterized by phonemic paraphasia and dysnomia, with the preservation of understanding. This was associated with grade III movement deficit in the left hand, which was predominantly in the first and second fingers, and grade IV deficit in the left leg. The superficial and deep reflexes were normal, with slight hypostasis for painful tactile stimulus of the left hand. The cranial pairs were also normal. Blood assays showed platelets and hepatic enzymes at normal levels (Table 1). NMR gave a low signal on T1 and a high signal on T2, and showed a variety of contrast impregnations (retentions) with ventricular white substance, at the callosal-septal interface, right-side centrum semiovale, corona radiata and thalamus bilaterally.