A rare case: Spontaneous subdural hematoma in dengue hemorrhagic fever

Dengue hemorrhagic fever (DHF) is caused by dengue virus infection. Complications of this disease can include neurological disorders in the form of intracranial hemorrhage (ICH), although neurological complications of dengue are infrequent, with an incidence below 1%. ICH, a manifestation of dengue complications, has been reported, including subdural hematoma (SDH). It has limited management guidelines and has a poor prognosis.

A 52-year-old man presented to the emergency department with a sudden loss of consciousness 1 h prior, preceded by a severe headache, nausea, and multiple episodes of vomiting the previous day. He was hospitalized 5 days earlier for DHF with a platelet count of 30,000/μL; he was discharged on day four. On admission, the patient was unresponsive with a fever (38.6°C), hypertension (160/90 mmHg), and a Glasgow Coma Scale of 3/15. Neurological examination revealed anisocoria with absent light reflexes. Laboratory results showed thrombocytopenia (74,000/μL) with otherwise normal hematological, coagulation, and renal parameters. Non-contrast head computed tomography demonstrated a large right frontotemporoparietal subacute SDH with midline shift and cerebral edema.

Dengue infection can progress from mild illness to severe disease with serious complications, including rare but potentially fatal ICH, such as SDH. These neurological complications are mainly related to severe thrombocytopenia, coagulation disorders, increased vascular permeability, and immune-mediated mechanisms. Early recognition of neurological warning signs, timely neuroimaging, and prompt multidisciplinary management are essential to reduce morbidity and mortality in patients with severe dengue.