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REPLY: REPLY: Clinical differentiation between dengue-related encephalopa- thy and encephalitis is difficult because almost all such cases have e thank Dr Pathum Sookaromdee and Professor Viroj significant metabolic derangement. The outcome related to en- WWiwanitkit for their interest in our recent publication. cephalitis is likely to be poorer compared with encephalopathy, The authors have stated that the brain imaging findings in cases and imaging has an important role in this differentiation. By dem- with dengue infection are nonspecific and are of little help in onstrating brain parenchymal involvement, one would have ad- diagnosis, management, or prognostication. ditional evidence to favor encephalitis over encephalopathy and To the best of our knowledge, our study is the single largest thus a guide to prognostication. Given improved medical man- dataset that includes positive cases of dengue infection with neu- agement of metabolic derangement and multiple-organ dysfunc- rologic symptoms attributed to the brain involvement. All these tions as seen with severe dengue, the role of imaging to help in cases have undergone cranial imaging. Our study demonstrates management (to rule out large hemorrhages) and prognostica- imaging features that may help to clinically raise the possibility of tion cannot be overemphasized. arboviral infections and also help in prognostication. The data published in this study show significant association with poor clinical outcome, which is defined as death or the presence of REFERENCE neurologic deficits at discharge with involvement of the thalami 1. Vanjare HA, Mannam P, Mishra AK, et al. Brain imaging in cases with and cerebellar peduncles and the presence of diffusion restriction positive serology for dengue with neurologic symptoms: a clinicora- and micro-/macrohemorrhages. diologic correlation. AJNR Am J Neuroradiol 2018;39:699–703 Reference articles 2, 3, and 5 used by the authors have little CrossRef Medline radiologic data, if any, to support their argument. Reference arti- X H.A. Vanjare cle 4 includes description of 6 cases, a small number to draw any X S. Mani conclusions. Department of Radiology Christian Medical College http://dx.doi.org/10.3174/ajnr.A5658 Vellore, India AJNR Am J Neuroradiol 39:E85 Jul 2018 www.ajnr.org E85 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

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Publisher
American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A5658
Publisher site
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Abstract

REPLY: Clinical differentiation between dengue-related encephalopa- thy and encephalitis is difficult because almost all such cases have e thank Dr Pathum Sookaromdee and Professor Viroj significant metabolic derangement. The outcome related to en- WWiwanitkit for their interest in our recent publication. cephalitis is likely to be poorer compared with encephalopathy, The authors have stated that the brain imaging findings in cases and imaging has an important role in this differentiation. By dem- with dengue infection are nonspecific and are of little help in onstrating brain parenchymal involvement, one would have ad- diagnosis, management, or prognostication. ditional evidence to favor encephalitis over encephalopathy and To the best of our knowledge, our study is the single largest thus a guide to prognostication. Given improved medical man- dataset that includes positive cases of dengue infection with neu- agement of metabolic derangement and multiple-organ dysfunc- rologic symptoms attributed to the brain involvement. All these tions as seen with severe dengue, the role of imaging to help in cases have undergone cranial imaging. Our study demonstrates management (to rule out large hemorrhages) and prognostica- imaging features that may help to clinically raise the possibility of tion cannot be overemphasized. arboviral infections and also help in prognostication. The data published in this study show significant association with poor clinical outcome, which is defined as death or the presence of REFERENCE neurologic deficits at discharge with involvement of the thalami 1. Vanjare HA, Mannam P, Mishra AK, et al. Brain imaging in cases with and cerebellar peduncles and the presence of diffusion restriction positive serology for dengue with neurologic symptoms: a clinicora- and micro-/macrohemorrhages. diologic correlation. AJNR Am J Neuroradiol 2018;39:699–703 Reference articles 2, 3, and 5 used by the authors have little CrossRef Medline radiologic data, if any, to support their argument. Reference arti- X H.A. Vanjare cle 4 includes description of 6 cases, a small number to draw any X S. Mani conclusions. Department of Radiology Christian Medical College http://dx.doi.org/10.3174/ajnr.A5658 Vellore, India AJNR Am J Neuroradiol 39:E85 Jul 2018 www.ajnr.org E85

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Jul 1, 2018

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