Catalan Mauro, Naccarato Marcello, Grandi Fabio Chiodo, Capozzoli Francesca, Koscica Nadia, Pizzolato Gilberto
Department of Clinical Medicine and Neurology, Azienda Ospedaliera-Universitaria Ospedali Riuniti di Trieste, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
Neurol Sci. 2009 Feb;30(1):55-7. doi: 10.1007/s10072-008-0003-9. Epub 2009 Jan 15.
Acute hemorrhagic leukoencephalitis (AHL) is a rare demyelinating disease mainly affecting children, characterized by acute onset, progressive course and high mortality. A 62-year-old man was admitted to our Unit for diplopia and ataxia ensuing 2 weeks after the onset of pneumonia. MRI T2-weighted images showed signal hyperintensities in the brainstem. Antibodies against Mycoplasma Pneumoniae and cold agglutinins were found. Two weeks later the patient had a worsening of his conditions: he developed left hemiplegia with motor focal seizures and the day after he was deeply comatose (GCS = 4). A second MRI scan showed extensive hyperintensities involving the whole right hemisphere white matter with a small parietal hemorrhagic area. The clinical and neuroimaging features suggested the diagnosis of AHL, Aciclovir in association with steroid therapy were administered and then plasmapheresis was started. After 30 days of coma, the patient gradually reacquired consciousness and motor functions; anyway a left hemiplegia persisted.
急性出血性白质脑炎（AHL）是一种罕见的脱髓鞘疾病，主要影响儿童，其特点为急性起病、病程进展迅速且死亡率高。一名62岁男性因肺炎发病2周后出现复视和共济失调入住我院。MRI T2加权像显示脑干信号增强。检测到抗肺炎支原体抗体和冷凝集素。两周后患者病情恶化：出现左侧偏瘫伴局灶性运动性癫痫发作，次日陷入深度昏迷（格拉斯哥昏迷评分=4分）。第二次MRI扫描显示广泛的高信号累及整个右侧半球白质，并伴有一个小的顶叶出血区。临床和神经影像学特征提示为AHL，给予阿昔洛韦联合类固醇治疗，随后开始血浆置换。昏迷30天后，患者逐渐恢复意识和运动功能；但左侧偏瘫仍然存在。
