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Citation:
Sharma R, Kearns C, Double doughnut sign. Reference article, Radiopaedia.org (Accessed on 11 Oct 2024) https://doi.org/10.53347/rID-192167
The double doughnut sign is a radiological sign described in MRI of viral encephalitis, typically due to dengue encephalitis.
The double doughnut sign refers to a pattern of signal changes in the bilateral thalami that have a doughnut-like appearance 1-4. This sign may be appreciated on either T2/FLAIR, diffusion-weighted imaging (DWI) or susceptibility weighted imaging (SWI), with bilateral round thalamic hyperintensities, each with a low signal core, that give the appearance of two (i.e. double) doughnuts 1-4. This appearance is thought to be due to bilateral thalamic hemorrhages occurring within surrounding edema and diffusion restriction 1-4.
This sign has been typically described, albeit rarely, in dengue encephalitis 1-4. However, there are case reports of its description in other flavivirus encephalitides (e.g. Japanese encephalitis) 1-4.
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1. Mishra A & Pandey S. Generalized Dystonia/Parkinsonism and Double‐Doughnut Sign in Dengue Encephalitis. Movement Disord Clin Pract. 2020;7(5):585-6. doi:10.1002/mdc3.12959 - Pubmed
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2. Pandeya A, Upadhyay D, Oli B et al. Dengue Encephalitis Featuring "Double-Doughnut" Sign - A Case Report. Ann Med Surg (Lond). 2022;78:103939. doi:10.1016/j.amsu.2022.103939 - Pubmed
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3. Balani A, Chatur C, Kumar A, Alwala S, Giragani S. “Double Doughnut” Sign – Could It Be a Diagnostic Marker for Dengue Encephalitis? Neurol India. 2019;67(5):1360. doi:10.4103/0028-3886.271276 - Pubmed
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4. Suresh S, Pannu A, Arora N, Chabra M. ‘Double Doughnut’ Sign in Japanese Encephalitis. QJM: An International Journal of Medicine. 2022;115(4):241-2. doi:10.1093/qjmed/hcac054 - Pubmed
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