Acute hemorrhagic leukoencephalitis in a COVID-19 patient-a case report with literature review.

Autor: Varadan B; Department of Radiology, Dr. Rela Institute and Medical Centre, Chromepet, Chennai, India., Shankar A; Department of Radiology, Dr. Rela Institute and Medical Centre, Chromepet, Chennai, India., Rajakumar A; Liver Intensive Care and Anaesthesia, Clinical Lead, Critical Care Services, Dr. Rela Institute and Medical Centre, Chromepet, Chennai, India., Subramanian S; Department of Neurology, Dr. Rela Institute and Medical Centre, Chromepet, Chennai, India., Sathya AC; Intensive Care, Department of Anaesthesia and ICU, Dr. Rela Institute and Medical Centre, Chromepet, Chennai, India., Hakeem AR; HPB Surgery and Liver Transplantation, Institute of Liver Diseases & Transplantation, Dr. Rela Institute & Medical Centre, Chromepet, Chennai, India., Kalyanasundaram S; Department of Radiology, Dr. Rela Institute and Medical Centre, Chromepet, Chennai, India. drksvasan@gmail.com.
Jazyk: angličtina
Zdroj: Neuroradiology [Neuroradiology] 2021 May; Vol. 63 (5), pp. 653-661. Date of Electronic Publication: 2021 Feb 11.
DOI: 10.1007/s00234-021-02667-1
Abstrakt: Purpose: Acute hemorrhagic leukoencephalitis (AHLE) is a rare and severe form of acute disseminated encephalomyelitis (ADEM). Only a few reports of AHLE in coronavirus disease 2019 (COVID-19) patients have been described to date. We report a case of COVID-19-related AHLE along with a literature review describing salient clinical and imaging characteristics.
Methods: A literature search was performed on Medline (2020-present), PubMed, Cochrane Library, CINAHL, and Google scholar on 28 January 2021 for all articles published using MeSH terms "COVID-19" or "SARS-CoV-2" with "Acute hemorrhagic leukoencephalitis" or "Acute hemorrhagic encephalitis." Relevant case reports and case series describing clinical and imaging features of AHLE associated with SARS-CoV-2 infection were included, data compiled, and critically reviewed.
Results: Acute onset encephalopathy and rapidly deteriorating neurological status is the common clinical presentation in AHLE. CSF analysis reveals elevated proteins and lymphocytic pleocytosis. Typical neuroimaging features include multifocal, variable-sized, poorly defined cerebral white matter lesions with cortical sparing. Involvement of the brainstem, cerebellar peduncles, and deep grey matter can also occur, although rarely. Lesions are hyperintense on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images, hypointense on T1W images, and show microhemorrhages, variable diffusion restriction, and post-contrast enhancement. Extensive microhemorrhages, brainstem involvement, and gross hemorrhage often portend a poor prognosis.
Conclusion: Heightened awareness about the clinical and imaging presentation of COVID-19-related AHLE can positively alter the outcome in a select few by enabling early diagnosis and aggressive management.
Databáze: MEDLINE
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