Neuroimaging in Dengue Seropositive Cases

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

• © 2018 by American Journal of Neuroradiology