Table 1 Timeline of events with diagnostic tests and interventions
Day of illness | Events | Diagnostic tests | Interventions |
|---|---|---|---|
01 | Onset of fever | ||
02 | Right ptosis and dysarthria | ||
03 | Bilateral asymmetric ptosis, complete ophthalmoplegia, mid-dilated pupils, swallowing difficulty due to palatal palsy, tongue deviation to right side, ataxia, and areflexia | Dengue NS-1 antigen positive Dengue RT-PCR positive | Admission to hospital, monitoring and fluid management for dengue fever |
04 | Non-contrast CT (brain) – normal | Intravenously administered polyclonal immunoglobulin started, supportive therapy | |
06 | Improvement of ophthalmoplegia and ptosis, resolution of fever | MRI (brain) – normal Nerve conduction studies – evidence of mild axonal polyneuropathy | |
07 | Dengue immunoglobulin M (serum) – positive | ||
08 | Improvement of ataxia, ability to walk without support | Intravenously administered polyclonal immunoglobulin (5 days) completed | |
12 | CSF studies – pus cells – nil, lymphocytes 2/μl, protein 20 mg/dl, sugar 80 mg/dl (random blood sugar 131 mg/dl) | ||
13 | Discharged from ward | ||
20 | Clinic review – complete neurological resolution | Discharged from clinic |