{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T06:02:21Z","timestamp":1785564141221,"version":"3.56.0"},"reference-count":28,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,1,28]],"date-time":"2024-01-28T00:00:00Z","timestamp":1706400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Neurohospitalist"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dengue neuro-infection can present with symptoms ranging from mild to severe. Atypical presentations, such as expanded dengue syndrome, pose diagnostic and therapeutic challenges. Neuroimaging findings, particularly the \u201cdouble-doughnut\u201d sign on brain magnetic resonance imaging (MRI), have emerged as one of the most valuable aids in diagnosing complex cases of central nervous system infection by dengue virus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We report the case of a 35-year-old female from rural West Bengal, India, with expanded dengue syndrome. The patient presented with fever, headaches, body aches, and sudden disorientation over minutes, which progressed to a coma. Neurological examination revealed profound unconsciousness and nuchal rigidity. Laboratory findings were consistent with dengue infection, including altered liver and pancreatic enzyme levels. The diagnosis was facilitated by identifying the \u201cdouble-doughnut\u201d sign on the brain MRI, which suggested dengue encephalitis. This finding and clinical and serological evidence guided the treatment strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The \u201cdouble-doughnut\u201d sign, though not exclusive to dengue encephalitis, proved crucial in this case, aiding in differentiating from other causes of encephalitis. Recognition of this sign can be pivotal in diagnosing expanded dengue syndrome, facilitating timely and appropriate intervention, and improving patient outcomes. This case also underscores the importance of considering dengue in the differential diagnosis of encephalitis, especially in endemic areas. Also, this case\u2019s excellent outcome (both clinically and radiologically) was noteworthy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19418744241230730","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T02:37:16Z","timestamp":1706495836000},"page":"316-321","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["An Intriguing Case of Expanded Dengue Syndrome With Co-existing Encephalitis, Pancreatitis, and Hepatitis: The Classic Thalamic \u201cDouble-Doughnut\u201d Sign Revisited"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4497-4478","authenticated-orcid":false,"given":"Uttam","family":"Biswas","sequence":"first","affiliation":[{"name":"Burdwan Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1766-4183","authenticated-orcid":false,"given":"Mois\u00e9s","family":"Le\u00f3n-Ruiz","sequence":"additional","affiliation":[{"name":"University Hospital \u201cLa Paz"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8192-0807","authenticated-orcid":false,"given":"Ritwik","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Burdwan Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utsab","family":"Joarder","sequence":"additional","affiliation":[{"name":"Burdwan Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khandokar Misbahul","family":"Islam","sequence":"additional","affiliation":[{"name":"Burdwan Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raghul","family":"Bheeman","sequence":"additional","affiliation":[{"name":"Burdwan Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1769-4809","authenticated-orcid":false,"given":"Juli\u00e1n","family":"Benito-Le\u00f3n","sequence":"additional","affiliation":[{"name":"University Hospital \u201c12 de Octubre\u201d"},{"name":"12 de Octubre (i+12)"},{"name":"Sobre Enfermedades Neurodegenerativas (CIBERNED)"},{"name":"Complutense University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,1,28]]},"reference":[{"issue":"12","key":"e_1_3_4_2_2","first-page":"904","article-title":"Clinical spectrum of dengue fever in a tertiary care centre with particular reference to atypical presentation in the 2012 outbreak in Kolkata","volume":"110","author":"Majumdar R","year":"2012","unstructured":"Majumdar R, Jana CK, Ghosh S, Biswas U. Clinical spectrum of dengue fever in a tertiary care centre with particular reference to atypical presentation in the 2012 outbreak in Kolkata. J Indian Med Assoc. 2012;110(12):904-906.","journal-title":"J Indian Med Assoc"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.44970"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.3422"},{"key":"e_1_3_4_5_2","first-page":"59","article-title":"Expanded dengue","volume":"64","author":"Kadam DB","year":"2016","unstructured":"Kadam DB, Salvi S, Chandanwale A. Expanded dengue. J Assoc Physicians India. 2016;64:59-63.","journal-title":"J Assoc Physicians India"},{"key":"e_1_3_4_6_2","unstructured":"World Health Organization Comprehensive guidelines for prevention and treatment of dengue and dengue hemorrhagic fever. New Delhi: WHO SEARO; revised and expanded edition. 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