Unique case : Dengue patient presents with stroke at Kauvery hospital

Chennai: Kauvery Hospital Chennai had announced the successful treatment of a unique case of dengue which presented with a stroke syndrome. The 42-year-old man was brought to the hospital with complaints of acute Speech Disturbance - Acute Dysphasia. Dysphasia is a speech disorder that affects a person's ability to speak. It can occur suddenly after a stroke or head injury or develop slowly from a growing brain tumour or other diseases of the brain.

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Speaking about the patient, Dr. Sivarajan Thandeeswaran, Senior Consultant, Stroke & Neurovascular Medicine, Kauvery Hospital Chennai, said, "Before consulting us, the patient had fever with chills for 3-4 days which subsided with self-medication. He then developed speech difficulties - he could not articulate words properly. On further examination, we found that there was no specific body or limb weakness. In view of his younger age we were wary about diagnosing a Stroke condition, which is generally a disease of older people.

An MRI scan however showed an infarct and hyperintense lesion in the Splenium of the Corpus Callosum. It has an interesting name - the Boomerang Sign; a boomerang is a curved piece of wood that returns to you when you throw it in a particular way! Only a handful of such cases are reported so far in the medical literature.

We immediately started administering medications such as Aspirin and Statin to treat his condition. However, a routine blood check-up detected a decrease in his Blood Platelets count, which had dropped to 67,000. Hence, we tested the patient for both COVID-19 and Dengue as platelet count drop is highly likely in the latter. The COVID test turned out to be negative. In the Dengue test, the NS1 antigen tested negative as he was already on the 6th day of his illness. (NS1 tests detect the non-structural protein NS1 of dengue virus and would be positive during the first two-three days of the illness.) But Dengue IgM and IgG turned out to be positive, which indicated that recent exposure to Dengue infection was highly likely. The LFT (Liver Function Test) showed slight derangements in some enzymes which also supported the diagnosis of Dengue.

He was treated for his dengue infection. He had no fever anymore, and his platelet count increased within two weeks to 1,13,000. Post-treatment MRI showed that the hyperintensity due to the infarct had reduced significantly, indicating good recovery."

"The unique question with regard to this patient's evolution of illness was how did the Dengue Fever progress to Acute Stroke. We were initially not able to confirm Dengue as the patient did not exhibit any typical symptoms. The treatment part was also challenging as we had to treat dengue, and help the patient recover his platelet count, while stroke treatment called for medications such as Aspirin that has anti-platelet properties," added Dr. Sivarajan.

Commenting on the success of the treatment, Dr. Aravindan Selvaraj, Co-founder & Executive Director, Kauvery Hospital, Chennai, said, "Unique cases like these provide great insights that shall guide care plans for patients who may present in future with similar challenges. The unexpected complication such as the dysarthria that developed in this patient is highly educative. We thoroughly study a patient's medical history before planning the most appropriate treatment.

In this case, the patient had self-medicated himself for Dengue, which then progressed to Acute Stroke. Complications such as this can be easily avoided by seeking treatment early. It is always advisable to avoid self-medication and consult the physician for any serious illness. I congratulate Dr. Sivarajan and team for the accurate diagnosis and helping him get back to his normal state of health."

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