Acute hemorrhagic encephalomyelitis in childhood: Case report and literature review

Abstract

Acute disseminated encephalomyelitis (ADEM) is an inflammatory immune-mediated disorder which is more common in pediatric patients. The clinical setting is characterized by a rapid onset of encephalopathy and multifocal neurological features. Acute hemorrhagic encephalomyelitis (AHEM) is considered a rare form of ADEM. This report shows a 2-year-old patient who presented with the classical features of ADEM and after 8 weeks developed severe neurological worsening. The second magnetic resonance image (MRI) showed hemorrhagic lesions. Differences in prognosis between ADEM and AHEM justify the investigation of AHEM whenever a patient has neurological recrudescence in a known patient of ADEM.

Keywords: Acute disseminated encephalomyelitis; acute hemorrhagic; childhood.

Figure 1

First Brain MRI. Axial FLAIR images demonstrating hyperintense extensive and confluent lesions in cerebellar white matter (a), affecting the corpus callosum (b) and compromising the central and juxtacortical white matter (c)

Figure 2

Second brain MRI. Axial FLAIR image (a) demonstrating hyperintense extensive and confluent lesions in central and juxtacortical white matter (dense arrow). Sagittal reformation (b) shows involvement of pericallosal and cerebellar white matter, sparing the U-fibers (dense arrows). Axial T2 gradient echo-weighted images (c and d) showing areas of very low signal, corresponding to breakdown products of hemoglobin (thin arrows), in the corpus callosum (c) and in the right centrum semiovale (d)