Shukla A, Nayyar N, Kumari P, Kumar A, Takkar P. Magnetic resonance imaging spectrum of acute hemorrhagic leukoencephalitis: Four case reports. World J Clin Cases 2025; 13(28): 107759 [DOI: 10.12998/wjcc.v13.i28.107759]
Corresponding Author of This Article
Ankit Shukla, Assistant Professor, Department of Surgery, Dr Rajendra Prasad Government Medical College, Tanda at Kangra Himachal Pradesh, Kangra 176001, Himachal Pradesh, India. nkitshukla@yahoo.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ankit Shukla, Department of Surgery, Dr Rajendra Prasad Government Medical College, Kangra 176001, Himachal Pradesh, India
Nishant Nayyar, Pooja Kumari, Ankush Kumar, Preeti Takkar, Department of Radiology, Dr Rajendra Prasad Government Medical College, Kangra 176001, Himachal Pradesh, India
Co-corresponding authors: Ankit Shukla and Nishant Nayyar.
Author contributions: All the authors did the literature search. Shukla A and Nayyar N wrote the first draft of the review, played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors; Nayyar N, Kumari P, Kumar A and Takkar P conceptualised the work, supervised the writing, and gave intellectual inputs. All the authors critically revised the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ankit Shukla, Assistant Professor, Department of Surgery, Dr Rajendra Prasad Government Medical College, Tanda at Kangra Himachal Pradesh, Kangra 176001, Himachal Pradesh, India. nkitshukla@yahoo.com
Received: March 30, 2025 Revised: April 22, 2025 Accepted: July 4, 2025 Published online: October 6, 2025 Processing time: 132 Days and 1.3 Hours
Abstract
BACKGROUND
Acute hemorrhagic leukoencephalitis (AHLE), also known as Weston-Hurst syndrome, is a very rare and fulminant form of demyelinating disorder. It is considered a hyperacute and severe variant of acute disseminated encephalomyelitis. Clinically, patients present with fever, headache, seizures, and altered sensorium, which can rapidly progress to coma or death. Magnetic resonance imaging (MRI) is the investigation of choice and plays a pivotal role in diagnosing AHLE. The purpose of this article is to make readers familiar with the typical MRI features of AHLE and to discuss differentials.
CASE SUMMARY
This case series reports the clinical presentation and typical neuroimaging findings in four patients diagnosed with AHLE. All patients presented with acute neurological symptoms, such as severe headaches, seizures, and altered consciousness, often following a history of fever suggesting an infectious etiology. Additionally, laboratory investigations demonstrated elevated levels of serum inflammatory markers and neutrophilic pleocytosis on cerebrospinal fluid analysis, supporting a post-infectious etiology. MRI findings consistently revealed characteristic white matter lesions with hemorrhagic foci and vasogenic edema, indicative of widespread demyelination characteristic of AHLE. The outcomes varied, with two patients surviving but experiencing neurological sequelae, while two others unfortunately succumbed to the disease. The clinical data, laboratory results, and imaging findings from this case series were systematically compared with those from previously published studies. The key similarities and differences in clinical presentation, imaging characteristics, and outcomes are presented in a tabulated format.
CONCLUSION
AHLE is associated with high morbidity and mortality rates, emphasizing the need for early recognition, prompt intervention, and multidisciplinary management. Further research is needed to explain the pathophysiological mechanisms underlying AHLE, identify potential biomarkers for early diagnosis, and develop targeted therapies to improve patient outcomes.
Core Tip: Acute hemorrhagic leukoencephalitis (AHLE) is a rapidly progressive demyelinating disorder often triggered by a viral infection. It involves widespread inflammation and bleeding in the brain, leading to neurological deterioration. Early recognition of symptoms such as confusion, seizures, or motor deficits is essential. Imaging studies, particularly magnetic resonance imaging (MRI), plays a vital role in diagnosis and monitoring treatment response. Timely administration of corticosteroids, immunosuppressive therapy, and supportive care can help manage the inflammation, reduce brain damage, and potentially improve prognosis.
