Role of Chandipura virus in an “epidemic brain attack” in Andhra Pradesh, India^[*]

Abstract

This is the first report of epidemic stroke and epidemic reversible ischemic neurological deficit. Objectives of this study were to confirm that strokes can occur in epidemics, to identify the association of any pathogen, to study its clinical characteristics, to study its pathology by neuroimaging, to know the arterial territory involved, to understand the effect of symptomatic treatment and to know if some ischemic cases are reversible. This is a cross sectional and case-control study. It included 55 stroke cases. It was performed in hospitals of Andhra Pradesh from 1st June 2003 to 12th August 2003. The cases were analyzed for age, sex, symptoms and signs, investigations done, treatment given and course of the disease. There was a 13-fold increase in the incidence of pediatric strokes. Diagnostic symptoms and signs included abdominal colic in 28 (50.91%), diarrhea without dehydration or dyselectrolytemia in 26 (47.27%), focal symptoms and signs in 33 (60%) and meningeal irritation signs in 0%. Cerebrospinal fluid, except for increased pressure, was normal in 100%. Computerized tomography revealed hypodensities restricted to middle cerebral artery territory. Twenty-eight (50.91%) cases had evidence of Chandipurainfection. Strokes do occur in epidemics. Though infection is the cause, etiologic role of Chandipura virus is doubtful. Enterovirus 71, Varicella and any other yet unidentified endotheliotropic virus should be investigated for. Epidemic stroke has characteristic features. Middle cerebral artery territory is involved. Early treatment of raised intracranial pressure significantly reduced Case Fatality Rate. Twenty-three (85.19%) of 27 survived cases recovered totally within 3 months. Two (7.41%) cases developed late onset refractory epilepsy and four (14.81%) continued to have hemiplegia after 8 months. (J Pediatr Neurol 2004; 2(3): 131–143).

Keywords

Chandipura virus - Chandipura stroke - Chandipura encephalitis - epidemic brain attack - epidemic stroke - epidemic reversible ischemic neurological deficit - neuroepidemiology

^* This article is dedicated to those children who succumbed to this new epidemic.