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  1. Article ; Online: Acute hemorrhagic leukoencephalitis in a COVID-19 patient-a case report with literature review.

    Varadan, Baskaran / Shankar, Abhinaya / Rajakumar, Akila / Subramanian, Shubha / Sathya, A C / Hakeem, Abdul Rahman / Kalyanasundaram, Srinivasan

    Neuroradiology

    2021  Volume 63, Issue 5, Page(s) 653–661

    Abstract: ... described to date. We report a case of COVID-19-related AHLE along with a literature review describing ... published using MeSH terms "COVID-19" or "SARS-CoV-2" with "Acute hemorrhagic leukoencephalitis" or "Acute ... of acute disseminated encephalomyelitis (ADEM). Only a few reports of AHLE in coronavirus disease 2019 (COVID-19) patients have been ...

    Abstract 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.
    MeSH term(s) COVID-19/complications ; Fatal Outcome ; Humans ; Leukoencephalitis, Acute Hemorrhagic/diagnostic imaging ; Leukoencephalitis, Acute Hemorrhagic/virology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pneumonia, Viral/complications ; Pneumonia, Viral/virology ; SARS-CoV-2 ; Tomography, X-Ray Computed
    Language English
    Publishing date 2021-02-11
    Publishing country Germany
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 123305-1
    ISSN 1432-1920 ; 0028-3940
    ISSN (online) 1432-1920
    ISSN 0028-3940
    DOI 10.1007/s00234-021-02667-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Acute Hemorrhagic Leukoencephalitis (AHLE)

    Mona Alromaihi

    BioMed Research International, Vol

    A Comprehensive Review on Causes, Symptoms, Link with COVID-19, Diagnosis, and Treatment

    2022  Volume 2022

    Abstract: Acute hemorrhagic leukoencephalitis (AHLE), also called Hurst disease, is a rare ... diagnostic criteria, diagnosis is difficult. The small number of cases described in the literature ... COVID-19) as a rare but serious neurological complication. However, due to the lack of evidence-based ...

    Abstract Acute hemorrhagic leukoencephalitis (AHLE), also called Hurst disease, is a rare demyelinating disease of the central nervous system (CNS) marked by rapid progression and acute inflammation of the white matter. Due to the correlation in their suspected postinfectious autoimmune pathogenesis, it is regarded as the most severe form of acute disseminated encephalomyelitis (ADEM). Because this clinical scenario has a high mortality rate, aggressive and immediate treatment is required. Although the exact cause of AHLE is unknown, it usually occurs after a bacterial or viral infection, or, less frequently, after a measles or rabies vaccination. AHLE has been reported in patients with coronavirus disease 2019 (COVID-19) as a rare but serious neurological complication. However, due to the lack of evidence-based diagnostic criteria, diagnosis is difficult. The small number of cases described in the literature, which most likely reflects underreporting and/or low incidence, necessitates greater public awareness. Increased clinical suspicion and early imaging identification of this entity may allow clinicians to pursue more aggressive treatment options, potentially reducing fatal outcomes. This study focuses on symptoms and causes of AHLE, difference between AHLE and ADME, diagnosis and treatment of AHLE, and its link with COVID-19.
    Keywords Medicine ; R
    Subject code 610
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Hindawi Limited
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Acute Disseminated Encephalomyelitis and Acute Hemorrhagic Leukoencephalitis Following COVID-19: Systematic Review and Meta-synthesis.

    Manzano, Giovanna S / McEntire, Caleb R S / Martinez-Lage, Maria / Mateen, Farrah J / Hutto, Spencer K

    Neurology(R) neuroimmunology & neuroinflammation

    2021  Volume 8, Issue 6

    Abstract: ... acute hemorrhagic leukoencephalitis (AHLE) following infection with COVID-19. Given their relatively rare occurrence, the primary ... from 8 countries alongside 4 patient cases from the authors' hospital files. COVID-19 infection was ... Methods: Patients with a history of COVID-19 infection were included if their reports provided adequate ...

    Abstract Background and objectives: Since the onset of the COVID-19 pandemic, a growing number of reports have described cases of acute disseminated encephalomyelitis (ADEM) and acute hemorrhagic leukoencephalitis (AHLE) following infection with COVID-19. Given their relatively rare occurrence, the primary objective of this systematic review was to synthesize their clinical features, response to treatments, and clinical outcomes to better understand the nature of this neurologic consequence of COVID-19 infection.
    Methods: Patients with a history of COVID-19 infection were included if their reports provided adequate detail to confirm a diagnosis of ADEM or AHLE by virtue of clinical features, radiographic abnormalities, and histopathologic findings. Cases purported to be secondary to vaccination against COVID-19 or occurring in the context of a preexisting relapsing CNS demyelinating disease were excluded. Case reports and series were identified via PubMed on May 17, 2021, and 4 additional cases from the authors' hospital files supplemented the systematic review of the literature. Summary statistics were used to describe variables using a complete case analysis approach.
    Results: Forty-six patients (28 men, median age 49.5 years, 1/3 >50 years old) were analyzed, derived from 26 case reports or series originating from 8 countries alongside 4 patient cases from the authors' hospital files. COVID-19 infection was laboratory confirmed in 91% of cases, and infection severity necessitated intensive care in 67%. ADEM occurred in 31 cases, whereas AHLE occurred in 15, with a median presenting nadir modified Rankin Scale score of 5 (bedridden). Anti-MOG seropositivity was rare (1/15 patients tested). Noninflammatory CSF was present in 30%. Hemorrhage on brain MRI was identified in 42%. Seventy percent received immunomodulatory treatments, most commonly steroids, IV immunoglobulins, or plasmapheresis. The final mRS score was ≥4 in 64% of patients with adequate follow-up information, including 32% who died.
    Discussion: In contrast to ADEM cases from the prepandemic era, reported post-COVID-19 ADEM and AHLE cases were often advanced in age at onset, experienced severe antecedent infection, displayed an unusually high rate of hemorrhage on neuroimaging, and routinely had poor neurologic outcomes, including a high mortality rate. Findings are limited by nonstandardized reporting of cases, truncated follow-up information, and presumed publication bias.
    MeSH term(s) Brain/diagnostic imaging ; Brain/pathology ; COVID-19/complications ; Encephalomyelitis, Acute Disseminated/etiology ; Encephalomyelitis, Acute Disseminated/mortality ; Encephalomyelitis, Acute Disseminated/physiopathology ; Encephalomyelitis, Acute Disseminated/therapy ; Glucocorticoids/therapeutic use ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Immunologic Factors/therapeutic use ; Intensive Care Units ; Leukoencephalitis, Acute Hemorrhagic/etiology ; Leukoencephalitis, Acute Hemorrhagic/mortality ; Leukoencephalitis, Acute Hemorrhagic/physiopathology ; Leukoencephalitis, Acute Hemorrhagic/therapy ; Magnetic Resonance Imaging ; Plasmapheresis ; SARS-CoV-2 ; Severity of Illness Index
    Chemical Substances Glucocorticoids ; Immunoglobulins, Intravenous ; Immunologic Factors
    Language English
    Publishing date 2021-08-27
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ZDB-ID 2767740-0
    ISSN 2332-7812 ; 2332-7812
    ISSN (online) 2332-7812
    ISSN 2332-7812
    DOI 10.1212/NXI.0000000000001080
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Acute Hemorrhagic Leukoencephalitis (AHLE): A Comprehensive Review on Causes, Symptoms, Link with COVID-19, Diagnosis, and Treatment.

    Alromaihi, Mona

    BioMed research international

    2022  Volume 2022, Page(s) 6008375

    Abstract: Acute hemorrhagic leukoencephalitis (AHLE), also called Hurst disease, is a rare ... diagnostic criteria, diagnosis is difficult. The small number of cases described in the literature ... COVID-19) as a rare but serious neurological complication. However, due to the lack of evidence-based ...

    Abstract Acute hemorrhagic leukoencephalitis (AHLE), also called Hurst disease, is a rare demyelinating disease of the central nervous system (CNS) marked by rapid progression and acute inflammation of the white matter. Due to the correlation in their suspected postinfectious autoimmune pathogenesis, it is regarded as the most severe form of acute disseminated encephalomyelitis (ADEM). Because this clinical scenario has a high mortality rate, aggressive and immediate treatment is required. Although the exact cause of AHLE is unknown, it usually occurs after a bacterial or viral infection, or, less frequently, after a measles or rabies vaccination. AHLE has been reported in patients with coronavirus disease 2019 (COVID-19) as a rare but serious neurological complication. However, due to the lack of evidence-based diagnostic criteria, diagnosis is difficult. The small number of cases described in the literature, which most likely reflects underreporting and/or low incidence, necessitates greater public awareness. Increased clinical suspicion and early imaging identification of this entity may allow clinicians to pursue more aggressive treatment options, potentially reducing fatal outcomes. This study focuses on symptoms and causes of AHLE, difference between AHLE and ADME, diagnosis and treatment of AHLE, and its link with COVID-19.
    MeSH term(s) Humans ; Leukoencephalitis, Acute Hemorrhagic/diagnosis ; Leukoencephalitis, Acute Hemorrhagic/etiology ; Leukoencephalitis, Acute Hemorrhagic/therapy ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19/therapy ; Encephalomyelitis, Acute Disseminated/complications ; Encephalomyelitis, Acute Disseminated/therapy ; White Matter/pathology
    Language English
    Publishing date 2022-11-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2698540-8
    ISSN 2314-6141 ; 2314-6133
    ISSN (online) 2314-6141
    ISSN 2314-6133
    DOI 10.1155/2022/6008375
    Database MEDical Literature Analysis and Retrieval System OnLINE

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