Dramatic clinical and radiological improvement in acute hemorrhagic leukoencephalitis: a case report

Abstract

Acute hemorrhagic leukoencephalitis (AHLE) is a rare, fulminant inflammatory demyelinating disorder considered a severe variant of acute disseminated encephalomyelitis and is associated with high morbidity and mortality, particularly in children. Early diagnosis remains challenging due to its rarity and overlap with other acute encephalopathies. We present the case of a previously healthy young 15-year-old Somali girl who exhibited acute headache, altered mental status, and cerebellar ataxia. Initial non-contrast computed tomography revealed diffuse cerebral edema with bilateral thalamic hemorrhagic involvement. Subsequent magnetic resonance imaging demonstrated extensive bilateral cerebral and cerebellar lesions with symmetrical involvement of the thalami and hippocampi, showing hemorrhagic transformation without contrast enhancement, findings consistent with acute hemorrhagic leukoencephalitis. MR venography was normal. The patient was treated with high-dose intravenous methylprednisolone and intravenous immunoglobulin, along with supportive care. A follow-up MRI done two weeks later showed that the lesions had gotten much better. The patient made a full neurological recovery and was sent to their home in excellent health. This case underscores the essential role of early clinical suspicion and distinctive MRI findings in diagnosing acute hemorrhagic leukoencephalitis. Starting aggressive immunomodulatory therapy right away can lead to huge improvements in both clinical and radiological outcomes, even in extreme cases and places with few resources. Heightened awareness of this uncommon condition is crucial for enhancing outcomes and decreasing related mortality.