Acute Hemorrhagic Leukoencephalopathy Triggered by COVID-19 Infection

Abstract

Background: This study represents an additional case of a rare entity and complication of COVID-19. Purpose: To further describe COVID's association with acute hemorrhagic leukoencephalopathy (AHL), a variant of acute disseminated encephalomyelitis. Besides, subsequent neuropsychological evaluation is described. Methods: The present case report describes clinical, laboratory, radiological, and electroencephalographic characteristics of AHL triggered by COVID-19, in addition to outcomes in the neuropsychological findings. Results: Radiologic findings of demyelinating lesions in supratentorial white matter permeated by multiple hemorrhagic foci supported the diagnostic of AHL, reinforced by clinical improvement after corticosteroid therapy. Conclusions: There are few similar cases previously reported, and this case highlights the early diagnosis and prompt treatment looking forward to better outcomes in AHL. Further studies are needed to elucidate the involved pathophysiological mechanisms.

Keywords: COVID-19; SARS-CoV-2; acute disseminated encephalomyelitis; acute hemorrhagic leukoencephalopathy.

Figure 1.

1.5 Tesla MRI axial fluid-attenuated inversion recovery (FLAIR) images of the patient at the onset of symptoms demonstrate bilateral diffuse, asymmetric, poorly marginated, subcortical hyperintensity lesions on the white matter (A, B). Axial T2-weighted image shows bilateral diffuse hyperintensity lesions of the white matter (C). The axial susceptibility-weighted imaging (SWI) shows hypointense lesions in the right temporal lobe, left temporal lobe, and both occipital lobes (D, E). Coronal FLAIR image demonstrates bilateral hippocampi involvement, predominantly on the right side, and thalami are spared (F).

Figure 2.

1.5 Tesla MRI axial fluid-attenuated inversion recovery (FLAIR) images of the patient one-month-later of the onset of symptoms demonstrate residual hyperintensity lesion on the right temporal lobe (A) and resolution of the other lesions (B). On the axial T2-weighted image, no lesions are detectable. (C). Axial susceptibility-weighted imaging (SWI) shows slightly hypointense lesions in the left temporooccipital region and hyperintense lesions in the right temporooccipital region, and both occipital lobes (D, E). Coronal FLAIR image demonstrates residual right hippocampi involvement (F).