Acute hemorrhagic leukoencephalitis: A Fatal Adult Case Highlighting the Diagnostic Value of MRI

Abstract

Acute hemorrhagic leukoencephalitis (AHLE) is a rare, fulminant hemorrhagic demyelinating disorder regarded as the most severe form of acute disseminated encephalomyelitis. A previously healthy 22-year-old woman presented with 2 days of fever, headache, vomiting, and meningeal symptoms, followed by drowsiness and signs of raised intracranial pressure. Emergency computed tomography showed diffuse sulcal effacement and a left parieto-occipital white-matter hypodensity containing punctate hyperdense foci. Magnetic resonance imaging demonstrated predominantly unilateral T2/FLAIR hyperintense lesions involving the left parieto-occipital white matter, middle cerebellar peduncle, cerebellar hemisphere, and vermis. The lesions were associated with marked vasogenic edema, susceptibility foci consistent with hemorrhage, mild parenchymal enhancement, and patchy leptomeningeal enhancement, without restricted diffusion. The clinicoradiological pattern supported a diagnosis of probable AHLE. According to the treating neurologist, immunotherapy was initiated; however, the specific agents, dosage, timing, and duration could not be retrieved from the available medical records. The patient’s neurological condition continued to deteriorate, and she died during hospitalization. The immediate cause of death could not be established. This case emphasizes that AHLE may show a predominantly unilateral supra- and infratentorial distribution and that susceptibility-weighted imaging is essential for identifying its hemorrhagic component.