Early detection of intracranial hemorrhage in Yellow Fever utilizing multimodal neuromonitoring: A case report

Yellow Fever (YF) is a vector-borne flavivirus infection that can rapidly evolve into fulminant hepatic failure (FHF), a condition associated with high mortality and severe neurological complications, including intracranial hemorrhage (ICH). Early identification of such complications remains a clinical challenge, especially in critically ill patients where the neurological examination is often limited. We present the case of a 60-year-old male with laboratory-confirmed YF by reverse transcription polymerase chain reaction, who developed ICH during the course of his illness. The implementation of a multimodal neuromonitoring approach-including near-infrared spectroscopy, transcranial Doppler, and jugular venous oxygen saturation-enabled the early detection of cerebral hemodynamic and perfusion changes suggestive of intracranial pathology. Despite the timely recognition of ICH, the patient's rapidly deteriorating coagulopathy, driven by FHF, precluded successful intervention, culminating in brain death. This case highlights the value of integrating advanced neuromonitoring modalities in the intensive care setting to enable prompt identification of life-threatening neurological complications. Although not sufficient to alter the fatal trajectory in this instance, early neuromonitoring may offer a critical window for therapeutic decision-making in patients with severe YF. Future research is needed to define standardized neuromonitoring protocols and to evaluate their impact on outcomes in this high-risk population.