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Every year during the monsoon and subsequent seasons, dengue outbreak starts spreading rapidly in different states of the country. Till now, there was a perception among the general public that dengue is only a disease characterized by high fever, unbearable pain in joints and reduction in the number of platelets in the blood. But in recent years, the ICU and neurology departments of hospitals have seen a surge in cases where dengue patients have suffered serious neurological complications such as sudden brain stroke, seizures, paralysis and coma. This dangerous situation in the medical world Neuro-Dengue Is being known as. Top neurologists and critical care experts say that if this threat to the brain during dengue infection is not recognized in time, it can be fatal or cause permanent disability for the patient.
Can dengue virus really reach the brain? The bitter truth of ‘neuro-dengue’
According to medical science, dengue viruses (DENV-1, DENV-2, DENV-3, DENV-4) are mainly spread by the bite of infected Aedes aegypti mosquito. For a long time it was believed that dengue virus only affects blood cells and the liver. However, modern neuro-imaging and medical research has proven that the dengue virus can bypass our body’s defense mechanisms. ‘Blood-Brain Barrier’ Has the ability to penetrate even.
When the patient’s immune system is severely weakened or the virus load increases excessively, the virus enters the brain tissues and central nervous system directly through the bloodstream. According to experts, about 1 to 5 percent of patients suffering from severe dengue are at risk of developing neurological complications, which at first glance hide behind normal dengue symptoms.
How does the risk of brain stroke arise in dengue? Know the science of both types of stroke
During dengue infection, a patient is at risk of two different types of brain stroke:
1. Hemorrhagic stroke (hemorrhage or bleeding in the brain): The biggest side effect of dengue is thrombocytopenia i.e. rapid fall of platelets. Platelets work to coagulate our blood and stop bleeding. When a patient’s platelets drop below 20,000 or 10,000 per microliter, and the walls of the microscopic blood vessels (capillaries) of the brain become weak due to the virus, then internal bleeding (Intracranial Hemorrhage) begins within the brain. This hemorrhagic stroke, caused by rupture of a brain vein, is extremely fatal and the risk of the patient’s death is highest.
2. Ischemic stroke (blood clot in the veins of the brain): In severe dengue, there is a problem of ‘Plasma Leakage’, in which fluid leaks from the blood vessels and starts accumulating in the lungs and stomach. Due to this, there is severe dehydration in the body and the blood becomes thick (Hypercoagulable State). When the blood thickens and starts forming clots in the arteries or the blood pressure suddenly falls very low due to Dengue Shock Syndrome, the supply of oxygen and blood to any part of the brain stops. This condition is called ischemic stroke, due to which a part of the patient’s body may become numb or paralyzed.
Dengue encephalopathy and encephalitis: other serious forms of brain infection
Apart from stroke, dengue virus can also damage the brain in two other major ways:
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Dengue Encephalitis: This is a condition when dengue virus directly reaches the brain cells and causes inflammation and infection there. Due to this, the patient starts having severe headache, stiff neck, irritation with light and frequent seizures.
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Dengue Encephalopathy: Many times the virus does not go directly to the brain, but due to dengue, due to acute liver failure, kidney failure or a sudden dangerous drop in the level of sodium in the body (Severe Hyponatremia), toxic toxins start accumulating in the brain. Due to its effect, the mental balance of the patient gets disturbed, he stops recognizing his family members and goes into deep unconsciousness (Altered Sensorium).
Don’t ignore these 6 ‘red flag’ neurological symptoms
During the treatment of dengue, if the patient shows any of the following symptoms apart from normal fever and body pain, then it should be considered as a neurological emergency and taken to the hospital immediately:
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Excessive and unbearable headache: If even after the fever subsides, severe, bursting pain in the head persists and normal medicines do not provide relief.
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Mental confusion and irritability: The patient may speak incoherently, not being aware of time and place, being extremely lethargic or unable to recognize family members.
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Seizures/Convulsions: Trembling of hands and legs, rolling of eyes or sudden stiffness of the body.
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Numbness of face or limbs (FAST Signs): Drooping on one side of the face, weakness in an arm or leg, or loss of function of one part of the body.
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Stuttering in speaking and difficulty in seeing: The patient’s voice may not come out clearly, his words will stammer or he may have blurred or double vision (double vision).
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Frequent vomiting and fainting: Nothing remains in the stomach, frequent vomiting and the patient continuously going into unconsciousness.
Do not take these medicines even by mistake: Deadly game of platelets and bleeding
The biggest mistake made during dengue is consumption of wrong medicines. Many people buy and consume painkillers from medical stores without prescription to get relief from headache and body ache.
Doctors have a strict warning that during dengue Aspirin, Ibuprofen, Diclofenac and Mefenamic Acid (Meftal-Spas) Consumption of non-steroidal anti-inflammatory drugs (NSAIDs) is completely prohibited. These medicines act like blood thinners and stop the function of platelets. Due to their consumption, the risk of fatal internal bleeding in the brain, stomach and intestines and hemorrhagic stroke increases manifold. For fever and pain in dengue, the use of ‘Paracetamol’ only and only in the prescribed dosage recommended by the doctor is considered safe.
Important suggestions and prevention protocols from doctors to keep the brain safe
It is essential to follow these basic precautions to avoid life-threatening complications like neurological and stroke during dengue infection:
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Adequate hydration is the biggest protective shield: A dengue patient should be given at least 3 to 4 liters of fluid daily. Drink ORS solution, coconut water, lemon water, lentil water and fresh fruit juice. Proper hydration prevents the blood from thickening and reduces the risk of ischemic stroke.
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Regular checking of hematocrit and platelet count: Keep an eye on not only platelets but also the ‘haematocrit’ level in the CBC test. An increase in hematocrit is a direct indication of plasma leakage and blood thickening.
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Balance of Electrolytes: Regularly check the level of sodium and potassium in the patient’s blood so that brain swelling (cerebral edema) caused due to sodium deficiency can be avoided.
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Timely contact with neurologist: If you notice even the slightest change in the patient’s behavior, get him admitted to a tertiary care hospital with MRI Brain or CT Scan facilities without any delay.
Considering dengue as just a seasonal fever and being careless at home can prove costly. Vigilance, selection of right medicines, adequate fluid intake and identification of early neurological symptoms can keep the patient completely safe from dengue as well as the serious risk of brain stroke.