Isolated subdural hematoma due to dengue hemorrhagic fever: Surgical intervention and review of the literature

BACKGROUND: Central nervous system (CNS) complications of dengue fever, a mosquito-borne single standard RNA virus illness, are reported in <1% of all cases. Hemorrhagic complications in severe forms of the disease can be life-threatening. The literature on cases, where hemorrhagic CNS complications necessitated neurosurgical intervention, is exceedingly sparse. The authors report their experience of a patient who developed an isolated acute subdural hematoma (SDH) due to dengue hemorrhagic fever (DHF) in the critical period of the illness with a poor prognosis. Despite a moribund patient, the SDH was immediately evacuated, achieving a good outcome. CASE DESCRIPTION: A 65-year-old male patient was admitted with high-grade febrile illness and diagnosed with dengue. The patient had no focal neurology and was managed adequately following the primary survey on admission but, then, developed severe thrombocytopenia and eventually the critical phase of dengue illness. On the 5(th) admission day, the patient collapsed. Glasgow Coma Score was 3/15 with bilaterally dilated, fixed pupils. Immediate computed tomography head revealed a large left SDH with a significant midline shift. SDH was emergently evacuated with two units of platelets transfused peroperatively and two additional units postoperatively. Thrombocytopenia resolved within 48 h, and interval scanning showed gradual resolution of SDH. The patient was discharged 18 days later. Five months later, on follow-up, the patient is well with mild left-sided weakness and an Extended Glasgow Outcome Score of 7. CONCLUSION: Isolated SDH is a rare but life-threatening hemorrhagic complication of DHF. Even in the critical phase of illness, with severe thrombocytopenia, surgical evacuation should be considered if the SDH is present in isolation, within an accessible area, and can be operated on immediately.