Acute hemorrhagic leukoencephalitis of Weston Hurst secondary to herpes encephalitis presenting as status epilepticus: A case report and review of literature

• Published in: Journal of clinical neuroscience Vol. 67; pp. 265 - 270
• Main Authors: Mondia, Mark Willy L., Reyes, Nikolai Gil D., Espiritu, Adrian I., Pascual V, Jose Leonard R.
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01-09-2019
• Subjects: Acute hemorrhagic leukoencephalitis; Herpes simplex virus encephalitis; Intracerebral hemorrhage; Status epilepticus; Weston-Hurst syndrome; Acute hemorrhagic leukoencephalitis; Status epilepticus; Weston-Hurst syndrome; Intracerebral hemorrhage; Herpes simplex virus encephalitis
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2019.06.020

•Acute hemorrhagic leukoencephalitis is a rare and fatal demyelinating disease.•This case presented a patient with an intracerebral hemorrhage in status epilepticus.•Treatment with high-dose methylprednisolone prevented mortality.
Acute hemorrhagic leukoencephalitis (AHL) is a rare and mostly fatal fulminant demyelinating disease. This case describes a 63-year old male in status epilepticus associated with an intracerebral hemorrhage following a one week viral prodrome with rapid decline to coma. He exhibited peripheral leukocytosis, neutrophilic pleocytosis with normal glucose and high protein in cerebrospinal fluid (CSF). Additionally, CSF was positive for herpes simplex virus (HSV) polymerase chain reaction (PCR). Medical decompression, low-dose dexamethasone, antibiotics and acyclovir were initially given. Magnetic resonance imaging (MRI) was suggestive of AHL, thus he was treated with methylprednisolone 1 g/day for 5 days. The patient improved and was discharged with significant neurologic morbidity. This is the first reported case of AHL in the Philippines presenting as a diagnostic dilemma with a protracted clinical course who responded to high dose intravenous steroids.