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Indian Journal of Emergency Medicine 11(4):p 271-274, Oct - Dec. 2025. | DOI: 10.21088/ijem.2395.311X.11425.11
Case Report
A Doughnut in the Brain
Jaislin Joseph, Varun H.S., Rajeshgopal Rao, Suhas Rao
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Licence:
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
Indian Journal of Emergency Medicine 11(4):p 271-274, Oct - Dec. 2025. | DOI: 10.21088/ijem.2395.311X.11425.11
How Cite This Article:
Joseph J, Varun HS, Rao R, et al. A Doughnut in the Brain. Ind J Emerg Med. 2025;11(4):271-4.Timeline
Received : July 15, 2025
Accepted : October 22, 2025
Published : December 30, 2025
Abstract
Dengue fever, a mosquito borne viral illness, is endemic in many parts of the world, particularly in tropical and subtropical regions. It is caused by four distinct serotypes (DENV 1–4) of single stranded RNA viruses from the Flaviviridae family. Although it is generally considered non-neurotropic, certain strains, especially DENV-2 and DENV-3, have been associated with neurological involvement. Neurological complications can include encephalopathy, encephalitis, meningitis, acute disseminated encephalomyelitis (ADEM), stroke, and Guillain-Barré syndrome. Dengue encephalitis, a relatively uncommon but serious manifestation, arises from direct viral invasion of neural tissue. This case report presents a patient with altered mental status and characteristic MRI findings symmetrical involvement of the thalami and cerebellum, known as the “double doughnut sign” indicative of dengue encephalitis. Cerebrospinal fluid analysis confirmed the diagnosis. Early recognition, neuroimaging, and supportive management with immunomodulation played a crucial role in the patient’s recovery. Clinicians should maintain a high index of suspicion for dengue encephalitis in endemic areas when encountering unexplained encephalopathy.
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Data Sharing Statement
There are no additional data available. All raw data and code are available upon request.
Funding
This research received no funding.
Author Contributions
All authors contributed significantly to the work and approve its publication.
Ethics Declaration
This article does not involve any human or animal subjects, and therefore does not require ethics approval.
Acknowledgements
We would like to express our gratitude to the patients, their families, and all those who have contributed to this study.
Conflicts of Interest
No conflicts of interest in this work.
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Cite this article
Joseph J, Varun HS, Rao R, et al. A Doughnut in the Brain. Ind J Emerg Med. 2025;11(4):271-4.
Licence:
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
| Received | Accepted | Published |
|---|---|---|
| July 15, 2025 | October 22, 2025 | December 30, 2025 |
DOI: 10.21088/ijem.2395.311X.11425.11
Keywords
Dengue feverInfectious encephalitisMRI findingsExpanded dengue syndrome & complicationsSearch for Similar Articles
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Timeline
| Received | July 15, 2025 |
| Accepted | October 22, 2025 |
| Published | December 30, 2025 |
licence
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
