Clinical Spectrum, neuroimaging, treatment, and outcomes of dengue-associated spinal cord involvement

Dengue-associated spinal cord involvement is an uncommon but clinically important neurological complication of dengue infection. Existing evidence is fragmented and largely limited to isolated case reports, case series, and small observational studies. This systematic review evaluated the clinical spectrum, neuroimaging findings, pathogenesis, treatment approaches, and outcomes of dengue-associated spinal cord involvement. A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Embase, Scopus, and Google Scholar were searched from inception to the final search date. Case reports, case series, and cohort studies describing spinal cord involvement associated with dengue infection were included. A total of 85 individual cases and 13 cohort studies were analyzed. Acute transverse myelitis (24/85, 28%) and longitudinally extensive transverse myelitis (22/85, 26%) were the most common syndromes, while hemorrhagic or compressive spinal cord syndromes accounted for 18/85 (21%). Neurological manifestations developed during the acute or parainfectious phase in 46/85 (54%) and during the postinfectious phase in 35/85 (41%). Long-segment spinal cord lesions were identified in 34/85 (40%), and hemorrhagic spinal lesions in 21/85 (25%). Brain or cranial nerve involvement accompanied spinal disease in 35/85 (41%). Intravenous corticosteroids were administered in 53/85 (62%) patients. Complete or near-complete neurological recovery occurred in 39/85 (46%), whereas persistent severe disability occurred in 11/85 (13%). Cohort studies confirmed that dengue-associated myelitis is rare but clinically significant. Dengue-associated spinal cord disease represents a heterogeneous neuro-immunological spectrum requiring early recognition and timely management.