Video
Video segment 1 Stereotypy involving left thumb and middle finger. Video segment 2: Bradykinesia with gait freezing and stooped posture.
Segment 1 Involuntary, patterned and coordinated snapping movements observed involving left thumb and middle finger which is partially suppressible.
Segment 2 Bradykinesia involving upper and lower limbs along with snapping movements in left hand as described and severe gait freezing.
Figure 1
CT brain axial (a) showing hypo density in bilateral basal ganglia and MRI findings (b)-T2 Axial, (c)-FLAIR Axial, (d)-T1 Axial, (e)-T2 coronal sequences showing bilateral basal ganglia involvement. (f)-T1 coronal at the level of basal ganglia without any contrast enhancement.
Table 1
Reports of various movement disorders following dengue encephalitis.
| S.NO. | STUDY AND YEAR | COUNTRY | AGE | GENDER | MOVEMENT DISORDERS | BRAIN MRI | DENGUE IGM ANTIBODY(SERUM) | DENGUE IGG ANTIBODY(SERUM) | DENGUE NS1 ANTIGEN | DENGUE IGM ANTIBODY(CSF) | REFERENCE NO |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Matta et al.2004 | Brazil | 10Yrs | Female | Diminished level of consciousness, spastic tetra paresis, cerebellar syndrome and frontal symptoms | Cerebral peduncle, lentiform nuclei and internal capsule signal changes on both sides | Diagnosis was made by ELISA | NA | NA | NA | [14] |
| 2 | Verma et al. 2011 | India | 34Yrs | Female | Opsoclonus Myoclonus Syndrome | Normal | Positive | NA | NA | NA | [15] |
| 19Yrs | Female | Opsoclonus Myoclonus Syndrome | Normal | positive | NA | NA | NA | ||||
| 3 | Karunarathne et al. 2012 | Sri Lanka | 43Yrs | Male | Ataxia | Hyperintesnity in bilateral cerebellar hemisphere spreading across vermis | Positive for Dengue and EBV | Positive | NA | NA | [16] |
| 4 | Azmin et al. 2013 | Malaysia | 18Yrs | Male | Parkinsonism with multiple cranial neuropathy with cerebellar ataxia and brachial plexopathy | Normal | Positive | Positive | Positive | NA | [7] |
| 5 | Withana et al. 2014 | Sri Lanka | 45Yrs | Female | Ataxia | Normal | Positive | Positive | Positive | NA | [17] |
| 6 | Fong et al. 2014 | Malaysia | 6Yrs | Female | Parkinsonism | Normal | Positive | NA | Positive | NA | [18] |
| 7 | Weeratunga et al. 2014 | Sri Lanka | 40Yrs | Female | Ataxia | Normal | Positive | NA | NA | Positive | [19] |
| 28Yrs | Male | Ataxia | Normal | Positive | NA | NA | Positive | ||||
| 25Yrs | Male | Ataxia | Bilateral and symmetrical T2 hyper intense lesions in the cerebellum | Positive | NA | NA | Positive | ||||
| 8 | Tan et al 2014 | Malaysia | 30Yrs | Male | Opsoclonus Myoclonus Syndrome | Pachy- and leptomeningeal enhancement. | Positive | Positive | NA | NA | [20] |
| 10Yrs | Male | Opsoclonus Myoclonus Syndrome | NA | Positive | NA | positive | NA | ||||
| 9 | Patel et al. 2017 | India | 16Yrs | Male | Ataxia | Signal intensity alteration in pons, medulla, superior, and middle cerebellar peduncles with patchy enhancement. | Positive | NA | NA | NA | [21] |
| 10 | Bopeththa et al. 2017 | Sri Lanka | 69Yrs | Male | Parkinsonism | Normal | Positive | Negative | Negative | Positive | [22] |
| 11 | Khoo et al. 2018 | Malaysia | 60Yrs | Male | Ataxia | Hyperintense signals at the right corona radiata and left frontal lobe (in keeping with old stroke). | Positive | NA | NA | NA | [23] |
| 12 | Desai et al. 2018 | India | 14Yrs | Male | Opsoclonus myoclonus | Normal | Positive | Positive | Positive | NA | [8] |
| 13 | Manapalli et al.2019 | India | 48Yrs | Male | Parkinsonism | Micro infarcts in the basal ganglia | Positive | NA | Positive | NA | [12] |
| 14 | Panda et al. 2020 | India | 13Yrs | Male | Parkinsonism | Normal | NA | NA | Positive | NA | [24] |
| 15 | Dudipala et al 2020 | India | 11Yrs | Female | Myoclonus | Normal | Positive | NA | NA | NA | [25] |
| 16 | Mishra et al. 2020 | India | 18Yrs | Female | Generalized dystonia/Parkinsonism | Double Doughnut sign | NA | NA | Positive | NA | [26] |
| 17 | Current study | India | 25 Yrs | Male | Stereotypy with parkinsonism | Bilateral basal ganglia T2/FLAIR hyper intensities | Positive | NA | Positive | NA |
[i] Abbreviations: NA-Not Available, Yrs-Years.