Intracranial hemorrhage in dengue fever: management and outcome A series of 5 cases and review of literature

Background: Dengue is one of the most important mosquito-transmitted arboviral diseases of tropical and subtropical parts of the world. It is estimated that 100 million cases occur per year, and 2.5 billion people at risk. Hemorrhagic complications causing encephalopathy is a rare but fatal. We discuss the management of 5 uncommon cases of intracranial hemorrhage in dengue. High index of suspicion is required for early diagnosis. Methods: Five of these patients with intracranial bleed were managed in neurosurgery unit. All the patients had deranged prothrombin time and thrombocytopenia. They were given platelet concentrates for correction of thrombocytopenia. All parameters and neurologic status were closely followed. Four of these patients had deterioration in neurologic status; 2 of them underwent surgery. Results: Two patients who underwent surgery had excellent outcome. One patient was managed conservatively with cerebral decongestants. Two patients with deep-seated bleed had very rapid deterioration and died. Conclusion: High index of suspicion in dengue is required especially during convalescence in those patients who are disoriented and have altered sensorium. It should not be misinterpreted as fever delirium or toxic encephalopathy. It needs immediate attention and investigation. Timely diagnosis and intervention can thus save many precious lives. (C) 2009 Elsevier Inc. All rights reserved.