Acute hemorrhagic leukoencephalitis mimicking herpes simplex encephalitis: case report

Acute hemorrhagic leukoencephalitis (AHLE) is a more severe form of acute disseminated encephalomyelitis (ADEM) characterized by a fulminant clinical course and the presence of hemorrhagic necrosis of the white matter. We report the case of a 57-year-old woman who developed delirium following a resp...

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Bibliographic Details
Published in:Arquivos de neuro-psiquiatria 2004-03, Vol.62 (1), p.139-143
Main Authors: Martins, Henrique Milhomem, Teixeira, Jr, Antônio Lúcio, Lana-Peixoto, Marco Aurélio
Format: Article
Language:English
Subjects:
acute disseminated encephalomyelitis
acute hemorrhagic leukoencephalitis
Anti-Inflammatory Agents - therapeutic use
Diagnosis, Differential
Encephalitis, Herpes Simplex - diagnosis
Encephalitis, Herpes Simplex - drug therapy
Female
Herpes simplex virus
herpes simplex virus encephalitis
Humans
Leukoencephalitis, Acute Hemorrhagic - diagnosis
Leukoencephalitis, Acute Hemorrhagic - drug therapy
Magnetic Resonance Imaging
Methylprednisolone - therapeutic use
Middle Aged
NEUROSCIENCES
PSYCHIATRY
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Summary:Acute hemorrhagic leukoencephalitis (AHLE) is a more severe form of acute disseminated encephalomyelitis (ADEM) characterized by a fulminant clinical course and the presence of hemorrhagic necrosis of the white matter. We report the case of a 57-year-old woman who developed delirium following a respiratory infection. Magnetic resonance imaging of the brain disclosed signal abnormalities in the frontal and temporal lobes, usually found in herpes simplex encephalitis (HSE). Gram stain, India ink and acid-fast bacilli staining were all negative in CSF as was a polymerase chain reaction (PCR) for herpes simplex virus. A diagnosis of AHLE was made and the patient was treated with i.v. methylprednisolone 1g/day for 5 days. Despite treatment, the patient developed several neurological sequelae compatible with the severity of her illness.
ISSN:0004-282X
1678-4227
0004-282X
1678-4227
DOI:10.1590/s0004-282x2004000100024