BACKGROUND

Neurological complications are increasingly being reported in dengue epidemics. Intra-spinal hematomas are rare and those associated with dengue fever are still rarer with only one being reported in literature.

METHODS

We report a case of dengue fever presenting with acute onset quadriparesis (upper limbs MRC 4/5 and lower limbs 0/5) and urinary incontinence. Patient was radiologically diagnosed with cervicodorsal acute to subacute anterior epidural hematoma. Based on clinical and radiological evaluations patient underwent an anterior cervical approach with manubriotomy, C6-D4 right anterolateral partial oblique corpectomies for evacuation of hematoma. Intraoperatively however there was no evidence of anterior epidural collection and the dura revealed a bluish hue. A durotomy revealed subdural hematoma. After evacuation of the hematoma patient remained paraplegic and her upper limb power worsened by MRC one grade. Postoperative MRI revealed good evacuation and no new bleed, however the intramedullary T2W signal hyperintensities extending up to C2 persisted. She was on ventilatory support for almost 5 months. For diaphragmatic incapacity she underwent bilateral cervical phrenic nerve stimulation (Diaphragmatic pacing). Inspite of initial improvement she succumbed to multiple underlying comorbidities.

CONCLUSIONS

Acute spontaneous SSDH's are extremely rare but should be kept in mind in patients with dengue haemorrhagic fever. The radiological findings could be deceptive and plain CT and MR should be used as complementary studies to establish the diagnosis of Acute spontaneous SSDH. The outcomes of SSDH are guarded and elaborate patient counselling preoperatively should be done keeping these in perspective.