Spectrum of Neurological Manifestations of Dengue in India

In order to detect the range of neurological manifestations, patients with dengue virus infection admitted to neurology service were subjected to detailed clinical evaluation, i.e. blood counts, serum chemistry, electrolytes, creatine kinase (CK), magnetic resonance imaging (MRI), nerve conduction study (NCS) and electromyography (EMG). Out of 24 patients with dengue virus infection aged 5–65 years, six had dengue shock syndrome (DSS) and 5 had dengue haemorrhagic fever (DHF). A total of 16 patients had encephalopathy (encephalomyelopathy 1) and 8 had pure motor quadriparesis. In the encephalopathy group, 6 had secondary causes; intracranial haemorrhage was present in 2, renal failure in 1 and hepatic failure in 3 patients. Cerebrospinal fluid (CSF) pleocytosis was present in 10 patients. The pure motor quadriparesis group had normal NCS, myopathic EMG and raised serum CK suggesting myositis. All the patients in the myopathy group improved, but in the encephalopathy group, 3 died, 2 had poor recovery, 3 partial and 8 had complete recovery. It can be concluded that neurological manifestations of dengue may have two polar forms – encephalopathy and myositis with varying degrees of overlap.