A 50 yr old male presented with decreased consciousness following fever for consecutive 5
days. Blood pressure was 120/70, pulse rate 100/min. Respiratory and cardiovascular system
examination was normal. There was no abdominal distention or vomiting. Skin rash was absent.
Jaundice was present.
Investigation showed blood leucopenia with moderate to severe anemia and thrombocytopenia.
Chest X-ray was normal. ECG was normal and echocardiogram revealed small pericardial
effusion. Liver function test revealed moderate hypoalbuminemia with mild hyperbilirubinemia.
Dengue NS 1 antigen test was positive. His decreased consciousness level in spite of normal
hemodynamic stability prompted us to get a CT scan of brain without contrast followed by CSF
study.
CT scan of brain revealed acute extra axial subdural hemorrhage (SDH) with extra dural
hemorrhage (EDH) along right hemisphere with displacement of ventricle to the left. CSF study
was deferred due the presence of mass effect.
Conservative management was done with PRBC and platelet transfusions. As his sensorium
and mass effect improvement occurred in following 3 days, the motor paresis of the patient did
not significantly improve thereby prompting the neurosurgeon to perform surgical evacuation
of SDH plus EDH. The patient had an uneventful recovery.