Spontaneous Spinal Epidural Hematoma in a Case of Dengue Fever - A Management Conundrum

Dengue fever is common health problem in the Indian subcontinent especially in the northern planes. While most of the cases recover uneventfully with supportive care, many have complications requiring hospital admission. Hemorrhagic complications are rare. Still rarer are complications involving the CNS. Even though, hemorrhages in CNS are routinely managed by neurosurgeons, in case of dengue fever with severe thrombocytopenia it is a "Scylla and Charybdis' like situation.To decompress the hemorrhage with operative intervention risks uncontrollable hemorrhage and not to emergently decompress risks life and limb of the patient. The most pragmatic approach for these situations is still evolving and there are no guidelines to help the individual surgeon navigate through such situations.Our case presents the similar dilemma. This young woman presented with quadriparesis which developed into plegia. However, because of very low platelet counts, she was not operated early on. The final result even after thorough decompression was very dismal. She continues to be quadriparetic (paraplegic) after almost 2 years of follow up. We feel that after explaining to the patients, the risks of surgery in presence of thrombocytopenia, the extradural hemorrhages should be evacuated with ongoing platelet correction instead of waiting for platelet counts to become normal.This has a higher chance of giving a useful life to the patient.