Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 58485

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : OD07 - OD09 Full Version

Paraparesis as a Rare Complication of Dengue Fever Causing Spontaneous Spinal Subarachnoid Haemorrhage

Published: October 1, 2022 | DOI:
Pradnya Diggikar, Simran Bhullar, Farhanulla Basha, Prashant Gopal

1. Professor, Department of General Medicine, Dr. DY Patil Medical Hospital and Research Centre, Pune, Maharashtra, India. 2. Junior Resident, Department of General Medicine, Dr. DY Patil Medical Hospital and Research Centre, Pune, Maharashtra, India. 3. Junior Resident, Department of General Medicine, Dr. DY Patil Medical Hospital and Research Centre, Pune, Maharashtra, India. 4. Junior Resident, Department of General Medicine, Dr. DY Patil Medical Hospital and Research Centre, Pune, Maharashtra, India.

Correspondence Address :
Dr. Farhanulla Basha,
Junior Resident, Department of General Medicine, Dr. DY Patil Medical Hospital and Research Centre, Pune, Maharashtra, India.


A smaller number of confirmed dengue cases worldwide present with neurological symptoms such as headache, seizure, neck stiffness, drowsiness, altered sensorium, behavioural disorders, delirium, cranial nerves palsies, and rarely, spinal cord involvement. This report is about a 54-year-old female patient with dengue, who presented with acute spinal cord compression due to spontaneous spinal Subarachnoid Haemorrhage (SAH). She complained of sudden onset of febrile illness associated with headache, myalgia, retro-orbital pain, and low backache for three days, followed by sudden onset paraplegia three days after the onset of the illness. A haemogram was obtained, which showed a platelet count of 60,000/μL. She had antibodies against dengue NS1 and dengue Immunoglobulin M (IgM), but not against dengue IgG. A Magnetic Resonance Imaging (MRI) spine contrast imaging revealed a spinal SAH from the level of T12 to L1, as well as significant cord compression. An MRI of the brain revealed a SAH in the bilateral parieto-occipital region. She underwent an emergency laminectomy and complete haematoma evacuation. Postsurgical period was uneventful with complete recovery of sensation and weakness. In patients from endemic areas of dengue infection who present with fever and spinal cord involvement a high degree of suspicion of this disease should arise and it should always be investigated further for dengue-related neurological complications.


Haematoma, Nervous system, Neurological manifestations, Spine

Case Report

A 54-year-old female presented with a three-day history of acute febrile illness, headache, retroorbital pain, and myalgia. Since the morning, on the day of presentation, she developed sudden onset bilateral lower limb weakness. Additionally, both lower limbs had impaired pain and touch sensation. There was no urine and bowel incontinence with no history of seizure or loss of consciousness.

On examination, her vital signs were normal; however, she was febrile (102°F) and covered in petechial rash over the abdomen, chest, and both lower limbs. Neurological examination revealed bilateral lower limb spastic paraparesis with grade 2/5 power at the ankles, knees, and hips. In both lower limbs, deep tendon reflexes were exaggerated. Bilateral planters were extensors (Babinski positive). At and below the T10 spinal level, she had impaired pain and touch perception. However, there was no bowel or bladder involvement. There was no significant family history for unusual medical condition. Patients’ routine laboratory investigations on admission showed thrombocytopenia and dengue serology positive for NS-1 and IgM (Table/Fig 1).

Subsequently, she underwent MRI spine contrast immediately on day 1, which revealed a SAH in the spinal column from T10 to L1 (Table/Fig 2). Later, when her headache did not resolve, she underwent MRI brain on day 2, which revealed bilateral parieto-occipital subarachnoid haemorrhage (Table/Fig 3). Based on the MRI spine and brain reports the diagnosis of SAH was arrived at, which was probably due to dengue infection presenting as paraparesis.

Following that, the patient underwent spinal laminectomy from T10 to L1 and the haematoma was removed to decompress the spinal cord. After six days of surgery, an MRI revealed no SAH and no other abnormal pathology (Table/Fig 4). By the sixth day of her illness, her platelet count improved to 2.1 lakhs/μL. She received rehabilitative and supportive care. Over the period of time of next two months her paraparesis improved, and the patient gained power of 5/5 in both lower limbs. On neurological examination, her reflexes were normal and both planters were flexors.


Dengue fever, a viral infection transmitted by mosquitos that causes a febrile illness, is a common disease in tropical and subtropical countries. Humans are infected with the virus via infected mosquitoes, Aedes aegypti and Aedes albopictus (1). The World Health Organisation estimates 390 million dengue virus infections per year of which 96 million manifests clinically (with any severity of disease). Another study estimated that 3.9 billion people are at risk of dengue infection. It has been stated that 70% of the risk burden falls in Asia, out of the 129 global countries (2),(3). A study by Bhatt S et al., estimated that India contributed 34 of 96 million apparent global dengue infections (3).

Dengue is frequently associated with fever, leukopenia, and thrombocytopenia, and it is usually self-limiting. In severe cases, it can result in vascular leakage and haemorrhagic manifestations that are characteristic of Dengue Haemorrhagic Fever (DHF). Expanded dengue syndrome is when fluid leaks and volume is lost, which causes severe shock, multiple organ failure, and death (4). Severe dengue kills between 0.5% and 3.5% of people in Asia (1),(5).

Only about 4% to 5% of confirmed dengue cases worldwide present with neurological symptoms (6). During the acute phase, neurological involvement manifests as encephalitis, myelitis, and meningitis – all of which are a result of the virus's direct invasion of the central nervous system (4).

Headache, seizure, neck stiffness, drowsiness, behavioural problems, delirium, cranial nerve palsies, and spinal cord involvement are some of the other symptoms [6,7]. The postinfectious phase may be associated with syndromes such as acute disseminated encephalomyelitis, neuromyelitis optica, optic neuritis, Guillain–Barré syndrome, myelitis, and oculomotor palsy. Encephalitis is the most common neurologic manifestations of them all. Spinal cord injury occurs infrequently during the postinfectious phase of dengue fever (8).

Pathophysiological mechanisms include viral infection of the CNS, metabolic disturbances impairing CNS function, haemorrhage, CNS inflammation, and viral-induced demyelination (7),(9). An acute spinal cord compression, paraparesis, and headache following a SAH in the brain are described in this case of dengue infection.

This report is about a non-traumatic spontaneous spinal and brain SAH associated with DF and thrombocytopenia. Based on the review of the literature, only one previous report of spinal SAH associated with dengue fever has been published (10). In the report published by Sharif NHM et al., the patient presented with history of fever and altered sensorium for 3 days and later she developed sudden onset bilateral lower limb weakness on day 4 of illness, similar to the index case except altered sensorium. On examination, this patient was confused and had bilateral 6th cranial nerve palsy and sensory level at T4 spinal level. The platelet count was 80,000/μL and dengue NS-1 antigen was positive. On MRI spine, SAH was found at level T4 extending till T9. In this case as well as the index patient, both of them underwent spinal laminectomy and haematoma removal. There is a report on similar dengue-related neurological manifestations in the context of dengue-induced myelitis, Guillain-Barre syndrome, and dengue myositis (11).

In the index case, symptoms were mostly due to combination of spinal cord oedema and haemorrhage, which caused cord compression in this particular instance of the patient. Because of the diluting and redistributing effects of cerebrospinal fluid (CSF), spinal SAH has only rarely been associated with spinal cord compression. Trauma, coagulopathy, and arteriovenous malformation are all known to be associated with this condition (12).

There are currently no proven antiviral treatments that can effectively treat dengue infection. One dengue virus serotype infection results in immunity to that virus for a brief period of time, but not for other serotypes. Most patients receive general supportive therapy, focussing on fluid replacement, intense haematological monitoring, and/or if required, blood transfusion. Supportive care and symptomatic treatment such as antiepileptics for seizures, as well as a cerebral decongestant including mannitol for elevated intracranial pressure in an intensive care unit should be provided. However, a number of vaccine preparations are being looked into. Notably, it is especially important to avoid Aedes mosquito bites in dengue-endemic regions (13). However, the majority of the reported cases with SAH had a delayed diagnosis, which leads to a high mortality rate. In fact, the problem may be controlled if proper dengue care is taken to limit the extent of the problem due to profound thrombocytopenia (14).

If there is no neurological deficit, a SAH in the spine may resolve spontaneously (15). When there is significant cord compression, as in this case, surgeons will recommend surgical laminectomy (16). The purpose of the surgery is to decompress the spine, which had already been accomplished by the laminectomy. It is possible that early surgical intervention resulted in a successful recovery following laminectomy.

Dengue virus was previously thought to be non neurotropic (17). However, neurological symptoms like encephalopathy and aseptic meningitis have become more common in recent years (7),(18). Seizures, SAH, intracranial bleeding, and neuropathies are additional neurological manifestations. Two patients in the present case series had encephalitis but no additional seizures. Three causes can be identified for the CNS manifestations: (a) the virus's direct neurotropic effect; (b) secondary to systemic manifestation; and (c) postinfectious sequelae, including immune-mediated reactions (19). There is a growing literature on the incidence and outcome of DF associated with atypical CNS manifestations like SAH. Intracranial haemorrhage predicts poor prognosis, significant morbidity and mortality (20). In a study conducted by Kulkarni R et al., neurological complications were seen in 2.64% of cases of which encephalopathy, encephalitis, and syncope were the commonest manifestations, followed by acute symptomatic seizures, intracranial bleed, and SAH (20). Even if diagnosed early, it is difficult, if not impossible, for general practitioners to take action because there is still uncertainty in management. This necessitates that healthcare delivery systems revise existing guidelines and develop strict protocols for managing such complications in order to reduce morbidity and mortality globally.


When it comes to recognising dengue-related neurological complications, a high index of suspicion is required. Patients from dengue-endemic areas who present with an acute febrile illness and atypical neurological manifestations should be considered for this diagnosis. Spinal SAH is a rare dengue fever complication. Clinicians must act quickly to diagnose and treat this condition to avoid irreversible neurological damage.


Rajapakse S. Dengue shock. J Emerg Trauma Shock. 2011;4(1):120-27. [crossref] [PubMed]
Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis. 2012;6(8):e1760. [crossref] [PubMed]
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013;496(7446):504-07. [crossref] [PubMed]
Dengue Guidelines for Diagnosis, Treatment, Prevention and Control Treatment, Prevention and Control. Accessed: 2022-09-13.
Gulati S, Maheshwari A. Atypical manifestations of dengue. Trop Med Int Health. 2007;12(9):1087-95. [crossref] [PubMed]
Puccioni-Sohler M, Soares CN, Papaiz-Alvarenga R, Castro MJC, Faria LC, Peralta JM. Neurologic dengue manifestations associated with intrathecal specific immune response. Neurology. 2009;73(17):1413-17. [crossref] [PubMed]
Li GH, Ning ZJ, Liu YM, Li XH. Neurological manifestations of dengue infection. Front Cell Infect Microbiol. 2017;7:449. [crossref] [PubMed]
Carod-Artal FJ. Neurological manifestations of dengue viral infection. Res Rep Trop Med. 2014;5:95-104. [crossref] [PubMed]
Solomon T, Dung NM, Vaughn DW, Kneen R, Thao LTT, Raengsakulrach B, et al. Neurological manifestations of dengue infection. Lancet. 2000;355(9209):1053-59. [crossref] [PubMed]
Sharif NHM, Misnan NA, Saidon N, Ooi PY, Hashim H. Spontaneous spinal subarachnoid haemorrhage: A rare complication of dengue fever. J Clin Health Sci. 2017;2(2):54-57. [crossref]
Puccioni-Sohler M, Rosadas C, Cabral-Castro MJ. Neurological complications in dengue infection: A review for clinical practice. Arquivos de Neuro-Psiquiatria. 2013;71(9 B):667-71. [crossref] [PubMed]
Kakitsubata Y, Theodorou SJ, Theodorou DJ, Miyata Y, Ito Y, Yuki Y, et al. Spontaneous spinal subarachnoid hemorrhage associated with subdural hematoma at different spinal levels. Emerg Radiol. 2010;17(1):69. [crossref] [PubMed]
Prabhat N, Ray S, Chakravarty K, Kathuria H, Saravana S, Singh D, et al. Atypical neurological manifestations of dengue fever: A case series and mini review. Postgrad Med J. 2020;96(1142):759-65. [crossref] [PubMed]
Wiwanitkit S, Wiwanitkit V. Acute brain hemorrhage in dengue. J Acute Dis. 2014;3(3):240-41. [crossref]
Kim YH, Cho KT, Chung CK, Kim HJ. Idiopathic spontaneous spinal subarachnoid hemorrhage. Spinal Cord. 2004;42(9):545-47. [crossref] [PubMed]
Ichiba T, Hara M, Nishikawa K, Tanabe T, Urashima M, Naitou H. Comprehensive evaluation of diagnostic and treatment strategies for idiopathic spinal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2017;26(12):2840-48. [crossref] [PubMed]
Bhoi SK, Naik S, Kumar S, Phadke RV, Kalita J, Misra UK. Cranial imaging findings in dengue virus infection. J Neurol Sci. 2014;342(1-2):36-41. [crossref] [PubMed]
Priyanka CHML, Bindu BH, Nivea B, Jacob M. A case series of atypical manifestations of dengue. APIK J Int Med. 2020;8(4):194-98. [crossref]
Singh A, Balasubramanian V, Gupta N. Spontaneous intracranial hemorrhage associated with dengue fever: An emerging concern for general physicians. J Family Med Prim Care. 2018;7(3):618-28. [crossref] [PubMed]
Kulkarni R, Pujari S, Gupta D. Neurological manifestations of dengue fever. Ann Indian Acad Neurol. 2021;24(5):693. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/55930.16869

Date of Submission: Feb 25, 2022
Date of Peer Review: Apr 21, 2022
Date of Acceptance: Jul 19, 2022
Date of Publishing: Oct 01, 2022

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Mar 15, 2022
• Manual Googling: Jul 14, 2022
• iThenticate Software: Sep 11, 2022 (14%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)