J Korean Child Neurol Soc.  2017 Mar;25(1):54-57. 10.0000/jkcns.2017.25.1.54.

Utility of Follow-up Diffusion Tensor Imaging in Acute Hemorrhagic Leukoencephalitis: a Case Report

• Choi WJ
• Byeon JH
• Eun SH
• Eun BL
• Kim GH

• KMID: 2385215
• DOI: http://doi.org/10.0000/jkcns.2017.25.1.54

Abstract

Acute hemorrhagic leukoencephalitis (AHLE) is an acute, rapidly progressing, fulminant demyelinating disease. It is a rare disease of the central nervous system with high mortality; survivors commonly present with significant neurological deficit. We report the case of a 16-month-old girl who survived AHLE and presented with the associated neurologic deficit. The patient came into the emergency department with febrile seizure. She showed bilateral pinpoint-sized pupils and hyperactive deep tendon reflexes. Her mental status was initially drowsy and rapidly progressed to stupor. Extensive demyelination and microbleeds were found in the cerebral white matter, thalamus and left cerebellum on Magnetic resonance imaging (MRI) scans. Her mental status was improved by intravenous administration of immunoglobulin and methylprednisolone. Five months after being discharged, increased white matter connectivity was found on color-coded follow-up MR diffusion tensor imaging (DTI) as compared to previous MRI. We therefore suggest adding the DTI technique when a follow-up MRI is performed in patients with AHLE. It could be useful to visualize the status of axonal injury and to encourage patients and their parents to continue the rehabilitation program.

Keyword

Acute hemorrhagic leukoencephalitis; Diffusion tensor imaging; Seizure; Child

MeSH Terms

Administration, Intravenous
Axons
Central Nervous System
Cerebellum
Child
Demyelinating Diseases
Diffusion Tensor Imaging*
Diffusion*
Emergency Service, Hospital
Female
Follow-Up Studies*
Humans
Immunoglobulins
Infant
Leukoencephalitis, Acute Hemorrhagic*
Magnetic Resonance Imaging
Methylprednisolone
Mortality
Neurologic Manifestations
Parents
Pupil
Rare Diseases
Reflex, Stretch
Rehabilitation
Seizures
Seizures, Febrile
Stupor
Survivors
Thalamus
White Matter
Immunoglobulins
Methylprednisolone