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Acute hemorrhagic leukoencephalitis (AHL) is characterized by an acute, rapidly progressive, monophasic, fulminant inflammatory hemorrhagic demyelination of white matter, usually postinfectious and associated with death or severe morbidity within a few days.1-3⇓⇓ We report MRI and neuropathology in a case of AHL.
Case report.
A 19-year-old white man was admitted with acute onset of fever, headache, and progressive lethargy. He had developed mild upper respiratory symptoms and cough 2 weeks earlier. Examination showed lethargy and meningismus, but he was arousable and oriented to person, place, and time. Brainstem responses were intact. Serum white blood count was 17.9 cells/uL. Head CT (not shown) revealed a left parietal hypodensity with mild mass effect. He was started on levofloxacin, ceftriaxone, and dexamethasone treatment. Brain MRI (figure, A) was performed while the patient was able to communicate and brainstem function was intact. Six hours later, he had a cardiopulmonary arrest and required resuscitation, intubation, and mechanical ventilation, after which he lost all brainstem function. He was treated with mannitol and hyperventilation, yet he was declared brain dead 12 hours after resuscitation and pronounced dead another 3 hours later. Blood cultures were negative. Nasopharyngeal cultures and serum …
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