Neuroimaging in Dengue Seropositive Cases
=========================================

* P. Sookaromdee
* V. Wiwanitkit

We read the publication “Brain Imaging in Cases with Positive Serology for Dengue with Neurologic Symptoms: A Clinicoradiologic Correlation” with a great interest.1 Vanjare et al1 concluded, “Although not specific, dengue infection has imaging findings that can be used to narrow down the differential list and help in prognostication.” We would like to share ideas and experiences from tropical Indochina on this finding. In fact, neurologic problems due to dengue are possible, but the brain imaging is usually not specific and might contribute little to the clinical diagnosis and management.2 Regardless of brain imaging findings, poor neurologic signs and symptoms are usually related to poor outcome.3 With similar positive brain imaging findings (presence of diffusion restriction and hemorrhagic foci in the brain parenchyma), worse prognosis is reported in patients with overt encephalitis symptoms.4 Nevertheless, the important determinant for good outcome is the appropriate clinical management by fluid-replacement therapy.2 In the previous study in Thailand, the cases with fatal dengue hemorrhagic fever usually had no positive brain imaging findings, and there was no prognostic advantage of brain imaging in patients with dengue.5

## References

1.  1. Vanjare HA, Mannam P, Mishra AK, et al. Brain imaging in cases with positive serology for dengue with neurologic symptoms: a clinicoradiologic correlation. AJNR Am J Neuroradiol 2018;39:699–703 doi:10.3174/ajnr.A5544 pmid:29439121
    
    [Abstract/FREE Full Text](http://www.ajnr.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIzOS80LzY5OSI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8zOS83L0U4NC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. Wiwanitkit V. Dengue fever: diagnosis and treatment. Expert Rev Anti Infect Ther 2010;8:841–45 doi:10.1586/eri.10.53 pmid:20586568
    
    [CrossRef](http://www.ajnr.org/lookup/external-ref?access_num=10.1586/eri.10.53&link_type=DOI) 
    
    [PubMed](http://www.ajnr.org/lookup/external-ref?access_num=20586568&link_type=MED&atom=%2Fajnr%2F39%2F7%2FE84.atom) 

3.  3. Misra UK, Kalita J, Mani VE, et al. Central nervous system and muscle involvement in dengue patients: a study from a tertiary care center. J Clin Virol 2015;72:146–51 doi:10.1016/j.jcv.2015.08.021 pmid:26513765
    
    [CrossRef](http://www.ajnr.org/lookup/external-ref?access_num=10.1016/j.jcv.2015.08.021&link_type=DOI) 
    
    [PubMed](http://www.ajnr.org/lookup/external-ref?access_num=26513765&link_type=MED&atom=%2Fajnr%2F39%2F7%2FE84.atom) 

4.  4. Wasay M, Channa R, Jumani M, et al. Encephalitis and myelitis associated with dengue viral infection clinical and neuroimaging features. Clin Neurol Neurosurg 2008;110:635–40 doi:10.1016/j.clineuro.2008.03.011 pmid:18467022
    
    [CrossRef](http://www.ajnr.org/lookup/external-ref?access_num=10.1016/j.clineuro.2008.03.011&link_type=DOI) 
    
    [PubMed](http://www.ajnr.org/lookup/external-ref?access_num=18467022&link_type=MED&atom=%2Fajnr%2F39%2F7%2FE84.atom) 
    
    [Web of Science](http://www.ajnr.org/lookup/external-ref?access_num=000257538000019&link_type=ISI) 

5.  5. Wiwanitkit V. Magnitude and pattern of neurological pathology in fatal dengue hemorrhagic fever: a summary of Thai cases. Neuropathology 2005;25:398 doi:10.1111/j.1440-1789.2005.00653.x pmid:16382792
    
    [CrossRef](http://www.ajnr.org/lookup/external-ref?access_num=10.1111/j.1440-1789.2005.00653.x&link_type=DOI) 
    
    [PubMed](http://www.ajnr.org/lookup/external-ref?access_num=16382792&link_type=MED&atom=%2Fajnr%2F39%2F7%2FE84.atom) 

*   © 2018 by American Journal of Neuroradiology