Acute Haemorrhagic Leukoencephalitis: Report of a Case

Acute haemorrhagic leukoencephalitis (AHL) usually involves the subcortical white matter but spares the cerebral cortex and subcortical U fibers. The outcome is usually fatal and very few survivors have been reported after decompressive therapy. An unusual presentation of a prolonged course of AHL in a 39-year-old man is reported. Initial brain magnetic resonance images (MRI) showed an irregular enhancing lesion in the left frontal area and another non-enhancing lesion in the right frontal subcortical white matter. A follow-up MRI 2 months later showed a remission of the right frontal lesion but a deterioration of the left frontal lesion. He received a decompressive craniotomy with left frontal lobectomy and pathological studies revealed an inflammatory reaction with haemorrhages involving the subcortical white matter. Interestingly, the haemorrhages also extended to the cortex and even to the meninges. Unfortunately, speech disturbance due to an epidural haematoma in the left fronto-parietal area was noted after the lobectomy. We conclude that AHL is unusual and the lesion may also involve the cortex and leptomeninges. Bleeding after decompression may be due to a post-operative complication or dura vessel involvement.