Unravelling Chikungunya’s Neurological Toll: A Case Report with Insights from Magnetic Resonance Imaging of Brain

Abstract

Chikungunya, an emerging neurotropic virus, has the potential to induce various neurological abnormalities. When suspecting encephalitis, it is imperative to test for the Chikungunya virus, which requires an early diagnosis and course of treatment. This is a case report of a 54-year-old male who presented with fever, giddiness, ataxia and slurred speech. Magnetic Resonance Imaging (MRI) brain revealed typical hallmark features of chikungunya encephalitis, with an incidental right cerebellopontine angle tumour. A positive serum chikungunya antigen Polymerase Chain Reaction (PCR) validated the diagnosis. The patient was initially managed in the Intensive Care Unit (ICU), showing a dramatic response to the treatment, and then shifted to the medicine ward for further observation and management. This case underscores the importance of considering chikungunya in patients presenting with encephalitis differential diagnosis, especially in endemic regions like India. Comprehensive imaging and PCR testing were instrumental in diagnosis. Treatment included supportive care, intravenous antibiotics, antivirals and steroids, leading to significant improvement. By day 12, notable recovery was observed, and follow-up MRI brain showed no new abnormalities. This case adds to the evidence of severe neurological manifestations of Chikungunya virus, highlighting the need for early recognition and management to improve outcomes. The concurrent presentation of chikungunya encephalitis and a cerebello-pontine angle tumour emphasises the necessity for thorough neuroimaging and PCR testing in suspected cases. The patient’s dramatic recovery following timely intervention demonstrates the potential for positive outcomes with appropriate management.

Keywords

• encephalitis
• encephalomyelitis
• neurotropic virus
• viral fever