title: Longitudinal extensive transverse myelitis with cervical epidural haematoma following dengue virus infection.
abstract: BACKGROUND
  Longitudinal extensive transverse myelitis associated with dengue infection is rare with no reported paediatric cases.
  
  
  METHODS
  We report a 12-year-old girl who presented with flaccid quadriplegia 8 days after onset of acute dengue fever. MRI spine showed T2 hyperintensity associated with epidural hematoma at C3-C6 level of the spinal cord. Transcranial magnetic brain stimulation revealed absent motor evoked potentials bilaterally. We also summarise and compare the reported cases of transverse myelitis associated with dengue infection.
  
  
  RESULTS
  Immunomodulatory treatment was given which included pulse methylprednisolone, intravenous immunoglobulin and plasmapharesis. Six months post-admission, there was a good (near-complete) clinical recovery with the repeat MRI showing mild residual hyperintensity at C4 level and complete resolution of epidural haematoma.
  
  
  CONCLUSIONS
  This is the first reported paediatric case of longitudinal extensive transverse myelitis following dengue infection. It is also the first to illustrate that in patients with concomitant epidural haematoma a good outcome is possible despite not having surgical decompression. Clinicians should be aware of parainfectious dengue-related longitudinal extensive transverse myelitis in children and consider prompt immunomodulatory treatment.
authors.affiliation: Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia. Electronic address: cyfong@ummc.edu.my.
authors.forename: Choong Yi
authors.initials: CY
authors.lastname: Fong
authors.affiliation: Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Paediatric Neurology Unit, Yangon Children's Hospital, Yangon, Myanmar.
authors.forename: Chaw Su
authors.initials: CS
authors.lastname: Hlaing
authors.affiliation: Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Chee Geap
authors.initials: CG
authors.lastname: Tay
authors.affiliation: Department of Biomedical Imaging, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Khairul Azmi Abdul
authors.initials: KA
authors.lastname: Kadir
authors.affiliation: Division of Neurology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Khean Jin
authors.initials: KJ
authors.lastname: Goh
authors.affiliation: Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Lai Choo
authors.initials: LC
authors.lastname: Ong
mesh_terms: D002648:Child; D003715:Dengue / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D003716:Dengue Virus; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009188:Myelitis, Transverse / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D011782:Quadriplegia / Q000821:virology
keywords: Demyelination; Dengue; Paediatric; Spinal cord; Transverse myelitis