Subdural haematoma and axonal polyneuropathy complicating dengue fever

The authors report a case of dengue fever presenting with aseptic meningoencephalitis and developing subdural haematoma and pure motor quadriparesis due to axonal polyneuropathy. This 27-year-old female patient presented to us during the latter part of the dengue epidemic in India in 2010. She had mild thrombocytopaenia and subtle signs of capillary leak. Dengue-specific IgM antibody was positive. She presented initially with recurrent seizures. Initial CT scan of brain was normal with cerebrospinal fluid showing albuminocytologic dissociation. After 6 days, the patient developed quadriparesis with areflexia. MRI showed bilateral subdural haematoma with no evidence of spinal nerve root compression. The nerve conduction study showed evidence of axonal neuropathy. The patient's quadriparesis improved such that she was able to walk with support after 4 weeks with conservative management. This case report highlights a possible association between dengue and motor axonal neuropathy subtype of Guillain-Barré syndrome.