Dengue Encephalitis Essay

638 words - 3 pages

Neuroimaging findings in dengue encephalitis are nonspecific, however occasionally it may provide additional clues for the diagnosis of dengue encephalitis. In dengue encephalitis, brain MRI can be normal or show focal parenchymal abnormalities [14]. Diffuse cerebral oedema is the the most common finding in dengue CNS infection. [6] Focal parenchymal change is the other major findings. Meningeal enhancement on post-contrast MRI has also been reported occasionally as well. [6] Cerebellar involvement in dengue infection is very rare. There are few previous reports describing cerebellar involvement in dengue infection. [22, 23, 24] In few cases cerebellar syndrome was result of post infectious acute disseminated demyelination. [23]. Small series from Sri Lanka reported three cases with cerebellar syndrome associated with dengue infection. Two of the patients were probably post infectious, while one possibly had acute infective cerebellitis and imaging in this patient showed symmetrical hyperintense lesions in the cerebellar hemispheres on T2W images. [24] Recent reports have also shown symmetrical involvement of the cerebellar hemispheres along with involvement of midbrain, thalamus and medial temporal regions in dengue encephalitis. Dengue cerebellitis is also supported by pathological studies showing presence of viral antigen in the cerebellar granular layer and purkinje cells. [15, 21]
On imaging lesions have usually been described as hyperintense on T2W images and hypointense on T1w images. Diffusion weighted imaging and susceptibility weighted imaging have not been systematically evaluated in cases of Dengue encephalitis. In our series, lesions showed restricted diffusion in 3 patients, facilitated diffusion was seen in 2 patients and in the remaining 2 patients combination of restricted and facilitated diffusion was seen. Increased blood brain barrier permeability is one of the hallmarks of dengue infection. This results in vasogenic edema which manifests as facilitated diffusion on DWI. However restricted diffusion seen on DWI may be attributed to presence of inflammatory cells, associated...

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