Dengue encephalitis

Changed by Rohit Sharma , 7 Jul 2024
Disclosures - updated 18 Aug 2023: Nothing to disclose

Updates to Article Attributes

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Dengue encephalitis is a rare condition resulting from direct involvement of the central nervous system by the dengue virus, it is one of many viral encephalitides and and flavivirus encephalitides.

Epidemiology

Dengue infection and dengue encephalitis, predominately occurs in tropical and subtropical areas of the world 1.

Clinical presentation

Dengue encephalitis presents similar to other forms of encephalitis with non-specific symptoms such as headache, seizures and altered level of consciousness.

Pathology

Dengue virus is a mosquito-transmitted RNA virus belonging to the flavivirus genus. There are four serotypes, designated DENV1-DENV-4 1. The The serotypes most commonly implicated in neurologic manifestations of dengue virus infection are DENV2 and DENV-3 2.

Radiographic features

Dengue encephalitis typically involves the basal ganglia, thalami, cortical grey matter, and subcortical and deep white matter. Rarely, lesions are found in atypical locations such as the brainstem (particularly the substantia nigra), cerebellum, and hippocampus 1.

CT
  • hyperattenuating intraparenchymal foci representing spontaneous macrohaemorrhages 1

MRI
  • T2/FLAIR: hyperintense hyperintense

  • DWI/ADC: affected regions demonstrate restricted diffusion in most cases 1

  • SWI:microhaemorrhages are commonly seen 1

In the thalami, the rare double doughnut sign may be appreciated 3.

Differential diagnosis

  • -<p><strong>Dengue encephalitis</strong> is a rare condition resulting from direct involvement of the central nervous system by the dengue virus, it is one of many <a href="/articles/viral-encephalitides">viral encephalitides</a> and <a href="/articles/flavivirus-encephalitis">flavivirus encephalitides</a>.  </p><h4>Epidemiology</h4><p><a href="/articles/dengue-fever">Dengue</a> infection and dengue encephalitis, predominately occurs in tropical and subtropical areas of the world <sup>1</sup>. </p><h4>Clinical presentation</h4><p>Dengue encephalitis presents similar to other forms of encephalitis with non-specific symptoms such as headache, seizures and altered level of consciousness. </p><h4>Pathology</h4><p>Dengue virus is a mosquito-transmitted RNA virus belonging to the <em>flavivirus </em>genus. There are four serotypes, designated DENV1-DENV-4 <sup>1</sup>. The serotypes most commonly implicated in neurologic manifestations of dengue virus infection are DENV2 and DENV-3 <sup>2</sup>.</p><h4>Radiographic features</h4><p>Dengue encephalitis typically involves the basal ganglia, thalami, cortical grey matter, and subcortical and deep white matter. Rarely, lesions are found in atypical locations such as the brainstem (particularly the substantia nigra), cerebellum, and hippocampus <sup>1</sup>.</p><h5>CT</h5><ul><li>hyperattenuating intraparenchymal foci representing spontaneous macrohaemorrhages <sup>1</sup>
  • -</li></ul><h5>MRI</h5><ul>
  • -<li>
  • -<strong>T2:</strong> hyperintense</li>
  • -<li>
  • -<strong>DWI/ADC: </strong>affected regions demonstrate restricted diffusion in most cases <sup>1</sup>
  • -</li>
  • -<li>
  • -<strong>SWI: </strong><a href="/articles/cerebral-microhaemorrhage">microhaemorrhages</a> are commonly seen <sup>1</sup>
  • -</li>
  • -</ul><h4>Differential diagnosis</h4><ul>
  • -<li>
  • -<a href="/articles/acute-disseminated-encephalomyelitis-adem-1">acute disseminated encephalomyelitis (ADEM)</a><ul>
  • -<li>haemorrhage is uncommon <sup>1</sup>
  • -</li>
  • -<li>the timing between the CNS manifestations and lesions and the febrile illness may assist in differentiating dengue encephalitis from ADEM - with dengue encephalitis manifesting during the febrile period and ADEM occurring after resolution of the acute illness <sup>1</sup>
  • -</li>
  • -</ul>
  • -</li>
  • -<li>
  • -<a href="/articles/japanese-encephalitis">Japanese encephalitis</a> <ul><li>
  • -<a href="/articles/acute-disseminated-encephalomyelitis-adem">​</a>haemorrhagic findings, although described, are less common <sup>1</sup>
  • -</li></ul>
  • -</li>
  • -<li>other <a href="/articles/flavivirus-encephalitis">flavivirus encephalitides</a>
  • -</li>
  • -<li>
  • -<a href="/articles/herpes-simplex-encephalitis">herpes simplex encephalitis</a><ul><li>usually spares the basal ganglia <sup>1</sup>
  • -</li></ul>
  • -</li>
  • +<p><strong>Dengue encephalitis</strong> is a rare condition resulting from direct involvement of the central nervous system by the dengue virus, it is one of many <a href="/articles/viral-encephalitides">viral encephalitides</a>&nbsp;and <a href="/articles/flavivirus-encephalitis">flavivirus encephalitides</a>.&nbsp;&nbsp;</p><h4>Epidemiology</h4><p><a href="/articles/dengue-fever">Dengue</a> infection and dengue encephalitis, predominately occurs in tropical and subtropical areas of the world <sup>1</sup>.&nbsp;</p><h4>Clinical presentation</h4><p>Dengue encephalitis presents similar to other forms of encephalitis with non-specific symptoms such as headache, seizures and altered level of consciousness.&nbsp;</p><h4>Pathology</h4><p>Dengue virus is a mosquito-transmitted RNA virus belonging to the <em>flavivirus </em>genus. There are four serotypes, designated DENV1-DENV-4 <sup>1</sup>.&nbsp;The serotypes most commonly implicated in neurologic manifestations of dengue virus infection are DENV2 and DENV-3 <sup>2</sup>.</p><h4>Radiographic features</h4><p>Dengue encephalitis typically involves the basal ganglia, thalami, cortical grey matter, and subcortical and deep white matter. Rarely, lesions are found in atypical locations such as the brainstem (particularly the substantia nigra), cerebellum, and hippocampus <sup>1</sup>.</p><h5>CT</h5><ul><li><p>hyperattenuating intraparenchymal foci representing spontaneous macrohaemorrhages <sup>1</sup></p></li></ul><h5>MRI</h5><ul>
  • +<li><p><strong>T2/FLAIR:</strong>&nbsp;hyperintense</p></li>
  • +<li><p><strong>DWI/ADC: </strong>affected regions demonstrate restricted diffusion in most cases <sup>1</sup></p></li>
  • +<li><p><strong>SWI:&nbsp;</strong><a href="/articles/cerebral-microhaemorrhage">microhaemorrhages</a> are commonly seen <sup>1</sup></p></li>
  • +</ul><p>In the thalami, the rare <a href="/articles/double-doughnut-sign" title="Double doughnut sign">double doughnut sign</a> may be appreciated <sup>3</sup>.</p><h4>Differential diagnosis</h4><ul>
  • +<li>
  • +<p><a href="/articles/acute-disseminated-encephalomyelitis-adem-1">acute disseminated encephalomyelitis (ADEM)</a></p>
  • +<ul>
  • +<li><p>haemorrhage is uncommon <sup>1</sup></p></li>
  • +<li><p>the timing between the CNS manifestations and lesions and the febrile illness may assist in differentiating dengue encephalitis from ADEM - with dengue encephalitis manifesting during the febrile period and ADEM occurring after resolution of the acute illness <sup>1</sup></p></li>
  • +</ul>
  • +</li>
  • +<li>
  • +<p><a href="/articles/japanese-encephalitis">Japanese encephalitis</a>&nbsp;</p>
  • +<ul><li><p><a href="/articles/acute-disseminated-encephalomyelitis-adem">​</a>haemorrhagic findings, although described, are less common <sup>1</sup></p></li></ul>
  • +</li>
  • +<li><p>other <a href="/articles/flavivirus-encephalitis">flavivirus encephalitides</a></p></li>
  • +<li>
  • +<p><a href="/articles/herpes-simplex-encephalitis">herpes simplex encephalitis</a></p>
  • +<ul><li><p>usually spares the basal ganglia <sup>1</sup></p></li></ul>
  • +</li>

References changed:

  • 3. Mishra A & Pandey S. Generalized Dystonia/Parkinsonism and Double-Doughnut Sign in Dengue Encephalitis. Mov Disord Clin Pract. 2020;7(5):585-6. <a href="https://doi.org/10.1002/mdc3.12959">doi:10.1002/mdc3.12959</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/32626815">Pubmed</a>

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