BACKGROUND Acute hemorrhagic leukoencephalitis(AHLE),also known as Weston-Hurst syndrome,is a very rare and fulminant form of demyelinating disorder.It is considered a hyperacute and severe variant of acute disseminat...BACKGROUND Acute hemorrhagic leukoencephalitis(AHLE),also known as Weston-Hurst syndrome,is a very rare and fulminant form of demyelinating disorder.It is considered a hyperacute and severe variant of acute disseminated encephalomyelitis.Clinically,patients present with fever,headache,seizures,and altered sensorium,which can rapidly progress to coma or death.Magnetic resonance imaging(MRI)is the investigation of choice and plays a pivotal role in diagnosing AHLE.The purpose of this article is to make readers familiar with the typical MRI features of AHLE and to discuss differentials.CASE SUMMARY This case series reports the clinical presentation and typical neuroimaging findings in four patients diagnosed with AHLE.All patients presented with acute neurological symptoms,such as severe headaches,seizures,and altered consciousness,often following a history of fever suggesting an infectious etiology.Additionally,laboratory investigations demonstrated elevated levels of serum inflammatory markers and neutrophilic pleocytosis on cerebrospinal fluid analysis,supporting a post-infectious etiology.MRI findings consistently revealed characteristic white matter lesions with hemorrhagic foci and vasogenic edema,indicative of widespread demyelination characteristic of AHLE.The outcomes varied,with two patients surviving but experiencing neurological sequelae,while two others unfortunately succumbed to the disease.The clinical data,laboratory results,and imaging findings from this case series were systematically compared with those from previously published studies.The key similarities and differences in clinical presentation,imaging characteristics,and outcomes are presented in a tabulated format.CONCLUSION AHLE is associated with high morbidity and mortality rates,emphasizing the need for early recognition,prompt intervention,and multidisciplinary management.Further research is needed to explain the pathophysiological mechanisms underlying AHLE,identify potential biomarkers for early diagnosis,and develop targeted therapies to improve patient outcomes.展开更多
Rationale:Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and den...Rationale:Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and dengue shock syndrome.Patient’s concerns:A 20-year-old male presented with a 2-day history of fever,multiple episodes of vomiting,and altered sensorium.Diagnosis:Dengue fever leading to acute hemorrhagic leukoencephalitis.Interventions:Multiple transfusions of single donor platelets,intravenous methylprednisolone,intravenous immunoglobulin,anti-seizure prophylaxis,and broad-spectrum antibiotics.Outcomes:Repeat brain magnetic resonance imaging showed resolution of lesions.The patient was subsequently discharged from the hospital in a healthy state.Lessons:This report helps us to gain a better understanding of the patient’s presentation,which will help to improve the timely recognition and prevention of this rare devastating presentation.展开更多
文摘BACKGROUND Acute hemorrhagic leukoencephalitis(AHLE),also known as Weston-Hurst syndrome,is a very rare and fulminant form of demyelinating disorder.It is considered a hyperacute and severe variant of acute disseminated encephalomyelitis.Clinically,patients present with fever,headache,seizures,and altered sensorium,which can rapidly progress to coma or death.Magnetic resonance imaging(MRI)is the investigation of choice and plays a pivotal role in diagnosing AHLE.The purpose of this article is to make readers familiar with the typical MRI features of AHLE and to discuss differentials.CASE SUMMARY This case series reports the clinical presentation and typical neuroimaging findings in four patients diagnosed with AHLE.All patients presented with acute neurological symptoms,such as severe headaches,seizures,and altered consciousness,often following a history of fever suggesting an infectious etiology.Additionally,laboratory investigations demonstrated elevated levels of serum inflammatory markers and neutrophilic pleocytosis on cerebrospinal fluid analysis,supporting a post-infectious etiology.MRI findings consistently revealed characteristic white matter lesions with hemorrhagic foci and vasogenic edema,indicative of widespread demyelination characteristic of AHLE.The outcomes varied,with two patients surviving but experiencing neurological sequelae,while two others unfortunately succumbed to the disease.The clinical data,laboratory results,and imaging findings from this case series were systematically compared with those from previously published studies.The key similarities and differences in clinical presentation,imaging characteristics,and outcomes are presented in a tabulated format.CONCLUSION AHLE is associated with high morbidity and mortality rates,emphasizing the need for early recognition,prompt intervention,and multidisciplinary management.Further research is needed to explain the pathophysiological mechanisms underlying AHLE,identify potential biomarkers for early diagnosis,and develop targeted therapies to improve patient outcomes.
文摘Rationale:Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and dengue shock syndrome.Patient’s concerns:A 20-year-old male presented with a 2-day history of fever,multiple episodes of vomiting,and altered sensorium.Diagnosis:Dengue fever leading to acute hemorrhagic leukoencephalitis.Interventions:Multiple transfusions of single donor platelets,intravenous methylprednisolone,intravenous immunoglobulin,anti-seizure prophylaxis,and broad-spectrum antibiotics.Outcomes:Repeat brain magnetic resonance imaging showed resolution of lesions.The patient was subsequently discharged from the hospital in a healthy state.Lessons:This report helps us to gain a better understanding of the patient’s presentation,which will help to improve the timely recognition and prevention of this rare devastating presentation.
