ALERD: acute leukoencephalopathy with restricted diffusion-a newly emerging diagnosis

Area of Science:

• Neurology
• Pediatrics
• Infectious Diseases

Background:

• Acute leukoencephalopathy with restricted diffusion (ALERD) is a severe clinical-radiological syndrome.
• It is characterized by encephalopathy, seizures, and restricted diffusion in the subcortical white matter.
• ALERD is associated with a higher incidence of neurological sequelae in children.

Purpose of the Study:

• To report three cases of ALERD following infection.
• To highlight the varying outcomes and the importance of early diagnosis and treatment.

Main Methods:

• Case series reporting three pediatric patients with ALERD.
• Clinical presentation, radiological findings (MRI), and outcomes were analyzed.
• Treatment with immunotherapy was administered in one case.

Main Results:

• All three cases followed a prodrome of fever and gastroenteritis, progressing to seizures and encephalopathy.
• Outcomes varied: one patient improved with immunotherapy and had mild sequelae, another had significant sequelae, and the third succumbed to death.
• One case presented with a central-sparing pattern on MRI but had rapid progression.

Conclusions:

• ALERD is a significant cause of acute encephalopathy in children.
• A high index of suspicion is required for prompt diagnosis.
• Early initiation of immunotherapy may lead to better neurological outcomes.