27 February 2022>: Articles
Acute Hemorrhagic Leukoencephalitis – A Rare but Fatal Form of Acute Disseminated Encephalomyelitis – Complicated by Brain Herniation: A Case Report and Literature Review
Unusual clinical course, Challenging differential diagnosis, Management of emergency care, Rare disease, Rare coexistence of disease or pathology
Hamza M. Alsaid A* , Mohammad A.A. Atawneh A , Sadi Abukhalaf A , Amro Daoud E , Abdurrahman Hamadah C , Kamel Gharaibeh ADOI: 10.12659/AJCR.935636
Am J Case Rep 2022; 23:e935636
Table 1. Comparison between AHLE cases reported in the literature, including type, time of treatment initiation, and clinical outcomes.
First author | Age (years) | Sex | Initial CNS issues | Medical treatment (time in HDs) | Surgical intervention (time in HDs) | Clinical outcomes | Radiologic findings |
---|---|---|---|---|---|---|---|
Ryan []3 | 31 | M | Aphasia, Comprehension deficit, Increased tone and extremity weakness, and Babinski reflex | High dose steroid (10) TPE (11) | Ventriculostomy (3)Decompressive craniotomy and bone flap removal (5) | Speaking and eating food (16 HD), Ambulating with normal tone and power (23 HD), 4 months f/u work full time | No radiologic findings reported |
Klein []4 | 34 | M | Extremity rhythmic activity, Tonic-clonic seizure, Status epilepticus, Brisk deep tendon reflexes and Babinski reflex | Dexamethasone, Phenytoin, Diazepam, Acyclovir (1st) | None | Extubated (2 HD), discharged (13 HD), 4 months f/u work full time | MRI on showed hyperintense regions involving the subcortical, frontal and temporal,parietal region, and subacute hemorrhage in right basal ganglia |
Elsheikh []7 | 49 | F | Drowsiness, Vertigo, Nausea, Hemiparesis, Deteriorated to deep coma | Corticosteroids, Cyclopho-sphamide (8) | External ventricular drain (2) | Persistent vegetative state (9 HD), Bilateral white matter lesions remained unchanged on f/u CT-scan (19 HD) | initial CT showed a right thalamic hemorrhage with blood within both lateral ventricles, third and fourth ventriclesMRI showed confirmed widespread bilateral white matter lesionswith increased signal in T2 and diffusion weighted images, pronounced in the centrum semiovale |
Catalan []5 | 62 | M | Diplopia, Ataxia, Nystagmus, Hemiplegia, Seizures, and Deteriorated to deep coma | Dexamethasone, plasmapheresis, Antibiotics, Aciclovir (1) | None | Slowly improved (after 30 HD), 5 months f/u persist left hemiplegia | Brain CT scan was normal, while MRI T2-weighted and FLAIR images showed an extensive area of signal hyperintensity involving bilaterally the posterior pontine and mesencephalic white matter and left corpus callosum |
Markus []19 | 34 | M | Dysphasia, Hemiparesis, Drowsiness, Neck stiffness, Facial weakness, and Absent gag reflex | Acyclovir, Antibiotics, phenytoin, and dexamethasone (1)Hyperventilation, mannitol, and lignocaine (2) Methylpred-nisolone (3) plasmapheresis, cyclopho-sphamide (9) | Lobectomy and bone flap removal (3) | First signs of recovery (14 HD), Extubated (17 HD), 9 months f/u minimal neurological deficits | Brain CT showed left frontoparietal oedema with mass effect causing effacement of the sulci and the frontal horn of the lateral ventricle and 5 mm midline shift |
Seals []20 | 50 | F | Headache, Slurred speech, Lethargic, Increased tone and extremity weakness, Brisk deep tendon reflexes, and Babinski reflex | Methylpre-dnisolone sodium succinate, oral prednisone (3) Cyclophos-phamide (8) | None | Spontaneous movements and meaningful Speech (9 HD), Mild recent memory impairment | Brain CT revealed a non-enhancing low-density area in the right frontal and parietal lobes, with a slight mass effect |
Rosman []21 | 6 | F | Decreased tone and extremity weakness, Opisthotonic, Dysphasia, Hemiplegia, and Babinski reflex | Dexamethasone, Acyclovir (4) | None | Difficult long-term memory and verbal expression (14 HD), Three weeks f/u ambulating with minimal neurological deficits | Normal findings on brain CT scanBrain MRI showed numerous bilateral non-enhancing white-matter lesions in the right centrum semiovale, both cerebral peduncles and the tectum. Findings resolved on discharge |