title: Deadly intracranial bleed in patients with dengue fever: A series of nine patients and review of literature.
abstract: BACKGROUND
  Dengue fever is a global pandemic threat with increasing incidence. To date, there are no cures and the effectiveness of dengue vaccines is still uncertain. World Heath Organization introduced expanded dengue syndrome to include unusual presentations of dengue fever including severe neurologic complications. One of the deadly complications is intracranial hemorrhage (ICH).
  
  
  METHODS
  We collected data of patients with ICH diagnosed via a plain computed tomography of the brain (CT brain) with thrombocytopenia and positive Dengue virus type 1 nonstructural protein (NS1) antigen test or positive dengue serology IgM from January 2014 till June 2015 at our center. Nine patients were included and all 20 other remaining patients reported in literature so far are discussed.
  
  
  CONCLUSIONS
  We found that all patients in our center requiring neurosurgical intervention died. Another interesting observation is that detection of Dengue IgG usually meant more severe ICH and poorer outcomes. From our series, platelet levels did not seem to influence the outcome.
  
  
  CONCLUSIONS
  We recommend that for early detection of ICH, Dengue IgG should be routinely screened and a high index of suspicion be maintained. Future research should be focused on determining predictors of ICH in patients with dengue fever so that preventive steps can be taken as mortality is high and no treatment seems beneficial at the moment once severe ICH occurs.
authors.affiliation: Department of Neurosurgery, Hospital Pulau Pinang, Jalan Residensi, 10990 Penang, Malaysia.
authors.forename: Jo Ee
authors.initials: JE
authors.lastname: Sam
authors.affiliation: Department of Neurosurgery, Hospital Pulau Pinang, Jalan Residensi, 10990 Penang, Malaysia.
authors.forename: Teak Sheng
authors.initials: TS
authors.lastname: Gee
authors.affiliation: Department of Neurosurgery, Hospital Pulau Pinang, Jalan Residensi, 10990 Penang, Malaysia.
authors.forename: Abdul Wahab
authors.initials: AW
authors.lastname: Nasser
keywords: Craniectomy; dengue encephalopathy; dengue fever; dengue hemorrhagic fever; intracranial bleed; intracranial hemorrhage