Delayed Spontaneuous Spinal Subdural Hemorrhage Following Dengue Fever: A Rare Case Report

Abstract

Introduction: Dengue fever is a mosquito-borne viral illness endemic to tropical and subtropical regions, including Southeast Asia. While most cases are self-limiting, severe complications such as bleeding diathesis and neurological involvement can occur. Neurological manifestations are rare, affecting less than 1% of patients, and spinal subdural hemorrhage (SSDH) is among the least reported.

Case Presentation: A 30-year-old man presented with acute spastic tetraparesis that began suddenly accompanied by sensory loss below the neck and urinary retention, one week after recovering from dengue fever. Neurological examination revealed global motor weakness, hypesthesia below C5, brisk reflexes, and positive bilateral pathologic reflexes, with no signs of meningeal irritation. Laboratory results showed mildly elevated liver enzymes and a history of thrombocytopenia during dengue infection. Cervical spine MRI with contrast demonstrated multifocal late subdural hemorrhage at C4–C7 with associated spinal cord myelopathy and mild canal stenosis.

Discussion: This case illustrates a rare neurological complication of dengue fever, where delayed spontaneous spinal subdural hemorrhage (SSDH) occurred despite only moderate thrombocytopenia. The proposed pathophysiology involves rupture of delicate intradural or bridging veins due to increased intraspinal venous pressure, compounded by dengue-associated endothelial dysfunction and coagulopathy. Hemorrhage into the subdural space may result from arachnoid membrane disruption or shear forces between the subarachnoid and subdural compartments. This supports the theory that even transient dengue-induced hemostatic imbalance can precipitate significant central nervous system bleeding.