A report describes a case of a 68-year-old man, who presented with a moderate grade, continuous fever for 15 days, and sudden onset weakness of the left half of the body with facial asymmetry ten days before admission. He did not have any skin rash or bleeding manifestation. He denied any history of hypertension, diabetes mellitus, or ischemic/valvular heart disease. 

• Clinical examination showed him to be conscious and oriented, febrile, with stable vitals and well-felt peripheral pulses.
• Neurological examination showed left upper motor neuron facial paresis, left motor hemiparesis (grade 1/5) with brisk deep tendon reflexes, and an extensor left plantar response.
• Hemogram showed leukocytosis with thrombocytopenia. His blood was positive for Non-structural protein 1 antigen for dengue.
• A cerebrospinal fluid (CSF) study revealed 15 cells (all lymphocytes) with normal protein and sugar levels.
• ELISA test showed positive for dengue-specific immunoglobulin M antibody and non-reactive for varicella zoster, herpes simplex, and Japanese encephalitis in serum and CSF.
• Magnetic resonance imaging of the brain revealed an acute infarct in the right parietal region.
• His 2D echocardiography and carotid doppler study were normal. 

The patient received conservative treatment and was discharged on low-dose aspirin 75 mg daily and advised limb physiotherapy. Follow-up after two months showed partial improvement in limb weakness.

Source: Verma R, Sahu R, Singh AS, Atam V. Dengue infection presenting as ischemic stroke: An uncommon neurological manifestation. Neurol India 2013;61:317-8