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Case Report

Bilateral facial weakness following dengue fever

Samir Patel , Rajeev Ranjan , Ritu Verma , C. S. Agrawal , Pooja Gupta 1
1
2
1
1
1 Department of Neurology, Sir Ganga Ram Hospital, New Delhi 110060, India.
2 Department of Nuclear Medicine, Sir Ganga Ram Hospital, New Delhi 110060, India.
A B S T R AC T
Dengue, an acute viral disease transmitted by Aedes mosquitoes, is highly endemic in many tropical and subtropical areas of the world.
Dengue has a wide clinical spectrum, ranging from mild clinical febrile illness to severe life-threatening conditions like dengue hemorrhagic
fever and dengue shock syndrome. Neurological complications of dengue infection have been observed more frequently in the recent past.
They are widespread and may involve almost all parts of nervous system through various pathogenic mechanisms. We report a case of a
30-year old male who developed bilateral facial weakness after dengue fever.

Key words: Bilateral facial weakness; dengue fever

INTRODUCTION syndrome probable Miller-Fisher syndrome, phrenic
neuropathy, long thoracic neuropathy, oculomotor
Dengue is second most common mosquito-borne palsy, maculopathy and fatigue syndrome. We report
[3]
[1]
disease affecting humans after malaria. Around a case of a 30-year old male, who developed bilateral
2.5 billion population is at risk of dengue infection facial weakness after dengue fever.
worldwide, and its endemic zone comprises more than
100 countries of the world. It is caused by arbo viruses CASE REPORT
which belong to the Flaviviridae family. Dengue
virus 1-4 are the known serotypes of the virus. The A 30-year-old male, without any significant past
[1]
clinical presentation of dengue has a wide spectrum, medical illness presented with difficulty in talking
ranging from mild clinical febrile illness to severe life- followed by difficulty in eating and drinking. His
threatening conditions like dengue hemorrhagic fever wife also noticed that he was unable to close his
and dengue shock syndrome. Recently, virological eyes. There was no history of any limb weakness or
characteristics of dengue viruses have been changing, paraesthesia. He also had fever for two weeks that
resulting in widespread neurological complications. [2] lasted for 3-4 days. On presentation, he was conscious,
alert and followed verbal commands. He was
Neurological manifestations of dengue infection hemodynamically stable and his physical examination
can be grouped into 3 categories: (1) concerned with was unremarkable. However, following a neurologic
neurotropism leading to encephalitis, meningitis, examination, a bifacial lower motor neuron weakness
myositis, rhabdomyolysis and myelitis; (2) related to the was marked. His motor and sensory examination was
systemic complications of dengue infection that can unremarkable.
lead to encephalopathy, stroke (both hemorrhagic and
ischemic), hypokalemic paralysis and papilledema; MRI scan of his brain with contrast study was
(3) post-infectious leading to acute disseminated concluded as normal. Electrophysiological evaluation
encephalomyelitis, encephalomyelitis, myelitis, of facial nerve revealed normal latency and reduced
neuromyelitis optica, optic neuritis, Guillain-Barré amplitude. His peripheral nerve conduction study was
normal. He was also evaluated for fever and found
Corresponding Author: Dr. Samir Patel, Department of
Neurology, Sir Ganga Ram Hospital, Old Rajinder Nagar, New
Delhi 110060, India. E-mail: samirpatel343@yahoo.com This is an open access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
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Cite this article as: Patel S, Ranjan R, Verma R, Agrawal CS, Gupta
P. Bilateral facial weakness following dengue fever. Neuroimmunol
Neuroinflammation 2016;3:63-4.
DOI: 10.20517/2347-8659.2015.48
Received: 03-11-2015; Accepted: 18-12-2015

© 2016 Neuroimmunology and Neuroinflammation | Published by Published by OAE Publishing Inc. 63