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Paediatric acute haemorrhagic leukoencephalitis.

Harshita Bamnawat1, Daisy Khera2, Siyaram Didel1

  • 1Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

BMJ Case Reports
|June 9, 2022
PubMed
Summary
This summary is machine-generated.

A previously healthy child experienced rapid neurological decline due to acute hemorrhagic leukoencephalitis (AHLE). Aggressive treatment led to a dramatic recovery, highlighting effective management strategies for this rare condition.

Keywords:
Neurology (drugs and medicines)Paediatric intensive carePaediatrics (drugs and medicines)

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Area of Science:

  • Pediatric Neurology
  • Neuroimmunology
  • Critical Care Medicine

Background:

  • Acute hemorrhagic leukoencephalitis (AHLE) is a rare, severe, and rapidly progressive demyelinating disease.
  • Early diagnosis and prompt intervention are crucial for favorable outcomes in AHLE.

Observation:

  • A preschool-aged girl presented with acute onset vomiting, headache, seizures, encephalopathy, and loss of consciousness, requiring ventilatory support.
  • Clinical examination revealed deep coma, dilated non-reactive pupils, absent brainstem reflexes, and flaccid quadriplegia.
  • Brain MRI demonstrated characteristic fluffy white matter hyperintensities and microhemorrhages.

Findings:

  • Laboratory and neuroimaging findings supported the diagnosis of acute hemorrhagic leukoencephalitis.
  • Aggressive treatment combining methylprednisolone, plasmapheresis, and intravenous immunoglobulin resulted in significant clinical improvement.
  • The patient experienced a dramatic recovery with no residual neurological deficits.

Implications:

  • This case underscores the potential for dramatic recovery in AHLE with intensive and multi-modal treatment, even in fulminant presentations.
  • Highlights the importance of early recognition and aggressive management in pediatric neuroinflammatory disorders.
  • Suggests that timely intervention can alter the course of severe AHLE, preventing long-term sequelae.