Ref Number = PITIKA-ASPR0134
Kartika Darmaya, Melanie Widjaja
OBJECTIVE: The clinical spectrum of dengue fever ranges from asymptomatic infection to expanded dengue syndrome. Dengue virus does not usually cause neurological manifestations. However, in recent years, neurological manifestations of dengue have been documented. Physicians must have a high index of suspicion or else this uncommon manifestation of the disease can be missed, in this case is dengue encephalitis.
CASE: We present a case of 13 year old girl with sudden loss of consciousness and one episode of projectile vomiting since 3 days before admission. She complained of headache 2 days and fever 12 hours before losing consciousness in which she took paracetamol but without any effects. Clinical examination on admission revealed GCS score 7 (E1M4V2), blood pressure 100/60mmHg, pulse 74x/minute, temperature 38?C. There were no signs of respiratory distress and bleeding manifestation. The physical examinations are unremarkable. The neurological examination revealed no neck stiffness. There was spastic in four extremities with no sign of lateralization, the clonus test was positive. The physiological reflexes were increase and pathological reflexes were absent. She developed one episode of generalized tonic seizure one day after admission. Investigations revealed hemoglobin-14,6g/dL, hematocrit-43,1%, leukocyte-2350/µL, platelet-47000/µL. Dengue virus NS-1 antigen test was reactive. Anti DHF IgG was positive. Anti DHF IgM was negative, therefore anti dengue IgA was performed to confirm dengue infection, the result was positive. MRI of the brain was normal. PCR was not performed due to lack of facility. She was treated with antiepileptic drugs and symptomatic treatment. Discharged from the hospital after 10 days, GCS score 11 (E4M5V2) remain spastic in four extremities, with hemodynamic compromise. 
CONCLUSION: Neurological manifestation in dengue infection is rare, but in endemic areas like Indonesia, dengue encephalitis should be considered in the differential diagnosis of fever with altered sensorium. The treatment is nonspecific, with mostly symptomatic treatment provided.
Keywords: dengue fever, loss consciousness, MRI brain, NS-1, seizures
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