RESUMEN
Introducción. El dengue es la arbovirosis más común que afecta al ser humano. No se conoce la frecuencia con la que esta infección vírica afecta al sistema nervioso central (SNC), aun cuando se han descrito casos aislados con complicaciones neurológicas en Asia y Sudamérica. En Rio de Janeiro (Brasil) la infección por el virus del dengue se ha convertido en un importante problema de salud pública. Casos clínicos. Los autores describen dos casos de afectación del sistema nervioso, inmunomediada, tras la infección clásica por el virus del dengue: una encefalitis aguda diseminada posinfecciosa y un síndrome de Guillain-Barré. En ambos casos, el diagnóstico de dengue se realizó mediante la técnica de ELISA, y se excluyeron otras etiologías virales en el líquido cefalorraquídeo (LCR).Una adolescente de 10 años de edad, tras un dengue clásico, presentó un cuadro de disminución de la conciencia, tetraparesia espástica, síndrome cerebelar y síntomas frontales. La resonancia magnética del encéfalo evidenció áreas de hiperseñal en secuencias T2 en el pedúnculo cerebral, los núcleos lentiformes y la cápsula interna bilateralmente, sugestivas de una encefalitis posinfecciosa. El segundo paciente, un varón de 14 años, tras un dengue clásico, presentó una tetraparesia ascendente flácida y arrefléxica, sugestiva de una polirradiculoneuritis aguda.El LCR mostró una disociación albuminocitológica. Su electroneuromiograma evidenció una polirradiculoneuropatía de carácter primariamente desmielinizante con componente axonal asociado.Conclusiones. Los mecanismos inmunológicos implicados en la fisiopatología de este tipo de complicaciones neurológicas tras el dengue pueden formar parte de la respuesta fisiológica a la infección viral (AU)
Introduction. Dengue is the most common of the arbovirosis that humans can suffer from. The frequency with which the central nervous system (CNS) is affected by this viral infection remains unknown, although isolated cases with neurological complications have been reported in Asia and South America. In Rio de Janeiro, Brazil, dengue virus infection has become an important public health concern. Case reports. The authors describe two cases of immune-mediated CNS involvement following classic infection by the dengue virus: one involving post-infectious disseminated acute encephalitis and the other consisting of Guillain-Barré syndrome. In both cases dengue was diagnosed using the ELISA technique, and other viral aetiologies in the cerebrospinal fluid (CSF) were excluded. A 10-year-old female, following a bout of classic dengue, presented symptoms of a diminished level of consciousness, spastic tetraparesis, cerebellar syndrome and frontal symptoms. A resonance brain scan showed areas of hypersignal in T2 sequences in the cerebral peduncle, lentiform nuclei and internal capsule on both sides of the brain, which suggested post-infectious encephalitis. The second patient, a 14-year-old male, presented an areflexive flaccid ascending tetraparesis that suggested acute polyradiculoneuritis, following a bout of classic dengue. CSF albuminocytologic dissociation was also observed. This patients electroneuromyogram recording showed a polyradiculoneuropathy of a primarily demyelinating nature with an associated axonal component. Conclusions. The immunological mechanisms involved in the pathophysiology of this type of neurological complications after suffering from dengue may be part of the physiological response to the viral infection (AU)
Asunto(s)
Humanos , Femenino , Niño , Adolescente , Masculino , Síndrome de Guillain-Barré , Encefalitis Viral , DengueRESUMEN
INTRODUCTION: Dengue is the most common of the arbovirosis that humans can suffer from. The frequency with which the central nervous system (CNS) is affected by this viral infection remains unknown, although isolated cases with neurological complications have been reported in Asia and South America. In Rio de Janeiro, Brazil, dengue virus infection has become an important public health concern. CASE REPORTS: The authors describe two cases of immune-mediated CNS involvement following classic infection by the dengue virus: one involving post-infectious disseminated acute encephalitis and the other consisting of Guillain-Barré syndrome. In both cases dengue was diagnosed using the ELISA technique, and other viral aetiologies in the cerebrospinal fluid (CSF) were excluded. A 10-year-old female, following a bout of classic dengue, presented symptoms of a diminished level of consciousness, spastic tetraparesis, cerebellar syndrome and frontal symptoms. A resonance brain scan showed areas of hypersignal in T2 sequences in the cerebral peduncle, lentiform nuclei and internal capsule on both sides of the brain, which suggested post-infectious encephalitis. The second patient, a 14-year-old male, presented an areflexive flaccid ascending tetraparesis that suggested acute polyradiculoneuritis, following a bout of classic dengue. CSF albuminocytologic dissociation was also observed. This patient's electroneuromyogram recording showed a polyradiculoneuropathy of a primarily demyelinating nature with an associated axonal component. CONCLUSIONS: The immunological mechanisms involved in the pathophysiology of this type of neurological complications after suffering from dengue may be part of the physiological response to the viral infection.