Spinal epidural haematoma post evacuation of spontaneous spinal intradural haematoma

Abstract Background Spinal haematomas are very rarely associated with dengue syndrome and usually occur at the time of active dengue fever. Late presentation after recovery from dengue fever, intradural haematoma, presentation as a multiloculated cystic lesion with longitudinal extensive myelitis and recurrence after surgery are very rarely or not described. Due to the peculiar association of all these findings, we report this case to provide an insight into the existence of such a rare presentation. Case description A 79-year-old-male developed sudden onset paraparesis after 1 week of recovery from dengue fever. The blood counts were normal. MRI of the thoracic spine was suggestive of intradural haematoma. The patient underwent emergency decompression and drainage of haematoma with recovery in the neurological status over the next few weeks. He presented to our emergency department after 5 weeks of the first surgery with deterioration in the neurological status to complete paraplegia. Repeat MRI showed posterior epidural collection bulging anteriorly causing cord compression and he was re-operated by decompression. There was no neurological recovery. Patient was managed with multi-disciplinary rehabilitation and he was independent in most of the activities at the time of discharge. Conclusion Spinal hematoma should be kept in mind in patients who present with neurological complications after dengue fever. It can have an atypical radiological presentation and may present with recurrent haemorrhage after surgery. Attention should also be given to delayed presentation of neurological complications which may develop even after weeks of recovery from dengue fever.