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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 A

DOI: 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 authorAge (years)SexInitial CNS issuesMedical treatment (time in HDs)Surgical intervention (time in HDs)Clinical outcomesRadiologic findings
Ryan []3 31MAphasia, Comprehension deficit, Increased tone and extremity weakness, and Babinski reflexHigh 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 timeNo radiologic findings reported
Klein []4 34MExtremity rhythmic activity, Tonic-clonic seizure, Status epilepticus, Brisk deep tendon reflexes and Babinski reflexDexamethasone, Phenytoin, Diazepam, Acyclovir (1st)NoneExtubated (2 HD), discharged (13 HD), 4 months f/u work full timeMRI on showed hyperintense regions involving the subcortical, frontal and temporal,parietal region, and subacute hemorrhage in right basal ganglia
Elsheikh []7 49FDrowsiness, Vertigo, Nausea, Hemiparesis, Deteriorated to deep comaCorticosteroids, 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 62MDiplopia, Ataxia, Nystagmus, Hemiplegia, Seizures, and Deteriorated to deep comaDexamethasone, plasmapheresis, Antibiotics, Aciclovir (1)NoneSlowly improved (after 30 HD), 5 months f/u persist left hemiplegiaBrain 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 34MDysphasia, Hemiparesis, Drowsiness, Neck stiffness, Facial weakness, and Absent gag reflexAcyclovir, 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 deficitsBrain 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 50FHeadache, Slurred speech, Lethargic, Increased tone and extremity weakness, Brisk deep tendon reflexes, and Babinski reflexMethylpre-dnisolone sodium succinate, oral prednisone (3) Cyclophos-phamide (8)NoneSpontaneous movements and meaningful Speech (9 HD), Mild recent memory impairmentBrain CT revealed a non-enhancing low-density area in the right frontal and parietal lobes, with a slight mass effect
Rosman []21 6FDecreased tone and extremity weakness, Opisthotonic, Dysphasia, Hemiplegia, and Babinski reflexDexamethasone, Acyclovir (4)NoneDifficult long-term memory and verbal expression (14 HD), Three weeks f/u ambulating with minimal neurological deficitsNormal 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

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923