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Computed tomography in acutehemorrhagic leukoencephalitis.

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Computed Tomography
in Acute Hemorrhagic
Ted L. Rothstein, MD, and Cheng-Mei Shaw, MD
In their recent paper, Lukes and Norman [a] provide useful
information on the computed tomographic (CT) findings in
acute disseminated encephalomyelitis. However, their discussion is diminished by an uncritical reliance on the report
of Reich and associates { 3 ] ; that report on C T findings in
acute hemorrhagic leukoencephalitis (AHL) tended to obscure the distinctive features of that rare but important disorder.
Acute disseminated encephalomyelitis and AHL are
linked by a similar pathogenesis and share common pathological factors, including perivenous demyelination and
mononuclear proliferation, with hemorrhagic and necrotic lesions characteristic of the more fulminant AHL [l]. AHL is a
rare, hyperacute, inflammatory disease of cerebral white matter with a rapid and catastrophic course. The clinical features
include progressive coma, pyramidal signs, seizures, and usually death.
Reich and associates [ 3 ] described the CT findings in a
patient they assumed to have AHL. Their patient presented
with a subacute illness from which he eventually recovered.
312 Annals of Neurology
Vol 1 5 No 3
March 1984
A brain biopsy and an initial CT scan showed no abnormalities. O n the seventeenth day, C T showed large symmetrical confluent areas of decreased attenuation involving the
white matter of both frontal lobes. The presentation, clinicd
course, C T findings, and lack of pathological confirmation
make a diagnosis of AHL unlikely.
We recently presented in the Annals 141 the C T findings in
a pathologically confirmed case of AHL. The distinctive features included decreased attenuation and mass effect resulting from edema and necrosis of the right frontoparietal centrum semiovale, and gyral contrast enhancement reflecting a
breakdown in the blood-brain barrier, all of which were apparent on C T within 18 hours of the onset of clinical symptoms. The focal and unilateral location of the lesion is an
important feature of AHL [ S ] , as is the rapid development of
C T abnormalities, which mirror the hyperacute clinical and
pathological changes.
It is now possible to make the diagnosis of AHL during lift:
on the basis of characteristic clinical and CT findings. It also
should be possible to apply immunological, biochemical, and
neurobiological methods to elucidate further the patho.genesis and consider therapeutic alternatives in AHL.
Northwest ProfesJ-iona/ Center
1570 N 115th, Suite2
Seattle, W A 9813.3
1. Gosztonyi G: Acute hemorrhagic leukocncephalitis (Hurst’s dis-ease). In Vinken PJ, Bruyn G W (eds): Handbook of Clinical
Neurology. Vol 3, Infections of the Nervous System, Part 11.
Amsterdam, Elsevier North-Holland, 1978, pp 587-604
2. Lukes SA, Norman D: Computed tomography in acute dis.seminated encephalomyelitis. Ann Neurol 13:567-572, 1983
3. Reich H, Lin S-R, Goldblart D: Computerized tomography in
acute hemorrhagic leukoencephalopathy: a case report. Ncurology (NY) 29:255-258, 1979
4. Rorhstein TL, Shaw C-M: Computerized tomography as a d i e nostic aid in acute hemorrhagic leukocncephalitis. Ann Ncurol
131331-333, 1983
5. Southcott R H , Fowler M: A further casc of acute hemorrhagic
leukoencephalitis. Med J Aust 32: 145-148, 1945
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leukoencephalitis, tomography, acutehemorrhagic, computer
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