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Acute hemorrhagic leukoencephalitis mimicking herpes simplex encephalitis: case report
Henrique Milhomem Martins1, Antônio Lúcio Teixeira, Marco Aurélio Lana-Peixoto
1Minas Gerais Center for Investigation of Multiple Sclerosis, Medical School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
Arquivos De Neuro-Psiquiatria
|May 4, 2004
Summary
Acute hemorrhagic leukoencephalitis (AHLE), a severe form of ADEM, presents with rapid neurological decline. This case highlights AHLE mimicking herpes simplex encephalitis, despite negative PCR, and discusses treatment outcomes.
Area of Science:
- Neurology
- Neuroimmunology
- Pathology
Background:
- Acute hemorrhagic leukoencephalitis (AHLE) is a rare, severe variant of acute disseminated encephalomyelitis (ADEM).
- AHLE is characterized by rapid onset, fulminant clinical course, and hemorrhagic necrosis of white matter.
- Distinguishing AHLE from other encephalitides, such as herpes simplex encephalitis (HSE), is critical for appropriate management.
Observation:
- A 57-year-old woman presented with delirium post-respiratory infection.
- Brain MRI revealed frontal and temporal lobe signal abnormalities suggestive of HSE.
- Cerebrospinal fluid (CSF) analysis, including PCR for herpes simplex virus, was negative.
Findings:
- Despite negative infectious workup, a diagnosis of AHLE was established.
- The patient received intravenous methylprednisolone (1g/day for 5 days).
- Neurological sequelae persisted despite treatment, reflecting the severe nature of AHLE.
Implications:
- This case underscores the diagnostic challenges in differentiating AHLE from HSE based on initial imaging.
- Early recognition and treatment of AHLE, though potentially limited by disease severity, are crucial.
- Further research into AHLE pathogenesis and optimal therapeutic strategies is warranted.