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Acute hemorrhagic leukoencephalitis with atypical features

Mauro Catalan1, Marcello Naccarato, Fabio Chiodo Grandi

  • 1Department of Clinical Medicine and Neurology, Azienda Ospedaliera-Universitaria Ospedali Riuniti di Trieste, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy. maurocatalan@libero.it

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|January 16, 2009
PubMed

Insights

Acute hemorrhagic leukoencephalitis (AHL), a rare pediatric demyelinating disease, occurred in a 62-year-old man post-pneumonia. Prompt treatment led to partial recovery, highlighting atypical presentations and management challenges.

Area of Science:

  • Neurology
  • Immunology
  • Infectious Diseases

Background:

  • Acute hemorrhagic leukoencephalitis (AHL) is a rare, severe demyelinating disorder typically affecting children.
  • Characterized by rapid onset, progressive neurological decline, and high mortality rates.
  • Adult-onset AHL is exceptionally rare, posing diagnostic challenges.

Observation:

  • A 62-year-old male presented with diplopia and ataxia following pneumonia.
  • Initial MRI revealed brainstem hyperintensities; serology showed Mycoplasma Pneumoniae antibodies and cold agglutinins.
  • Clinical deterioration included hemiplegia, seizures, and coma, with subsequent MRI showing extensive white matter lesions and hemorrhage.

Findings:

  • The patient's presentation and neuroimaging findings were consistent with adult-onset AHL.
  • Treatment involved Aciclovir, steroids, and plasmapheresis.
  • Partial neurological recovery was observed after a prolonged coma, with persistent hemiplegia.

Implications:

  • This case expands the known demographic of AHL to include older adults.
  • It underscores the importance of considering AHL in adult neurological emergencies, especially post-infectious.
  • Early diagnosis and multimodal treatment may improve outcomes in this rare condition.

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