Acute Haemorrhagic Leucoencephalitis Complicating Sepsis

Tanser, S J; Walker, Martin B.; Hilton, DA

doi:10.1177/0310057x0102900111

Cited by 6 publications

(7 citation statements)

References 10 publications

(7 reference statements)

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“…Seizures have been variably reported; our figure of 36.5% is similar to that of another pediatric series (35%), 8 although others have reported seizures in only 13%. 2 A very rapid, markedly severe symptomatology suggesting acute hemorrhagic leukoencephalomyelitis has been described 13,14 ; two of our cases had such a presentation.…”

Section: Discussionsupporting

confidence: 54%

“…Acute disseminated encephalomyelitis can occur at any age but is most commonly seen in children; the mean age of 6.14 years at presentation in our study is similar to 5.9 and 5.3 years seen in other pediatric series. 2 A very rapid, markedly severe symptomatology suggesting acute hemorrhagic leukoencephalomyelitis has been described 13,14 ; two of our cases had such a presentation. 3 Viral illnesses and immunizations are the most common antecedent events in 51% to 74% of cases, [8][9][10] as was also seen in our series.…”

Section: Discussionmentioning

confidence: 48%

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Acute Disseminated Encephalomyelitis in North Indian Children: Clinical Profile and Follow-Up

et al. 2006

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Acute disseminated encephalomyelitis in children is not uncommon in developing countries, yet there is little systematic documentation of its clinical profile and follow-up. We studied the clinical and neuroradiologic features of acute disseminated encephalomyelitis in 52 consecutive children. Clinical details, magnetic resonance imaging (MRI) findings, and the results of other investigations were recorded, and children were followed up from 6 to 48 months. A repeat MRI was done after 3 to 4 months, and in those with persistent lesions, another MRI was done after 6 to 7 months of discharge. The mean age at presentation was 6.14 +/- 3.17 years, 73.1% were male, and 17 children had a history of antecedent infectious illness or vaccination. Most children had a meningoencephalitic presentation, with sudden-onset motor weakness in 76.9% and seizures in 36.5%. Altered sensorium and pyramidal signs were seen in 55.8% and 80.7% of children, respectively. On MRI, scattered T(2)-weighted hyperintense lesions were seen, mainly in the subcortical white matter, especially in the parietal (53.8%) and frontal (30.17%) regions. Thalamic, basal ganglia, and callosal lesions were seen in 30.76%, 17.3%, and 13.46% of cases, respectively. Variable contrast enhancement was seen in 48% of those who had contrast MRIs. The response to methylprednisolone was good, with dramatic recovery in 26.9% and marked improvement in 51.9% at discharge. On follow-up, of 44 children, residual smaller MRI lesions were seen in 30. The MRI was repeated at 6 months in children with residual lesions, and it was found that the lesions either disappeared or were significantly reduced after 6 months in 75% of cases. Four children had relapse of acute disseminated encephalomyelitis with new lesions on MRI. All of them responded to methylprednisolone. None of the clinical or neuroradiologic factors at presentation had any significant correlation with relapse. Six months after discharge, no deficits could be found in 61.3% of cases; 15.9% and 4.5% had motor and cognitive deficits, and 9% had multiple deficits. The presentation of pediatric acute disseminated encephalomyelitis in developing countries is similar to that in developed countries. In spite of an aggressive presentation, most children respond well to corticosteroids. MRI lesions disappear or are significantly reduced at 6 months in the majority of cases.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 48%

Acute Disseminated Encephalomyelitis in North Indian Children: Clinical Profile and Follow-Up

et al. 2006

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“…In-hospital (nurses, physicians, and respiratory therapists) and community (family) healthcare providers are mainly responsible for taking care of patients with tracheostomies [35] . A simulation-based tracheostomy educational program for in-hospital healthcare providers has been suggested to enhance the quality of care for these patients [27,36] …”

Section: Discussionmentioning

confidence: 99%

“…Recent research has shown a lack of familiarity and confidence in tracheostomy care among physicians and ward nurses, leading to inevitable and potentially serious complications [26,27] . Hence, it is necessary to design an education program to improve tracheostomy-related knowledge and care skills of in-hospital healthcare providers [28–31] .…”

Section: Introductionmentioning

confidence: 99%

Immersive virtual reality (VR) training increases the self-efficacy of in-hospital healthcare providers and patient families regarding tracheostomy-related knowledge and care skills

et al. 2022

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Background: Virtual reality (VR)-based simulation in hospital settings facilitates the acquisition of skills without compromising patient safety. Despite regular text-based training, a baseline survey of randomly selected healthcare providers revealed deficiencies in their knowledge , confidence , comfort , and care skills regarding tracheostomy. This prospective pre–post study compared the effectiveness of regular text- and VR-based intervention modules in training healthcare providers ’ self-efficacy in tracheostomy care skills. Methods: Between January 2018 and January 2020, 60 healthcare providers, including physicians, nurses, and respiratory therapists, were enrolled. For the intervention, a newly developed head-mounted display (HMD) and web VR materials were implemented in training and clinical services. Subsequently, in-hospital healthcare providers were trained using either text or head-mounted display virtual reality (HMD-VR) materials in the regular and intervention modules, respectively. For tracheostomy care skills, preceptors directly audited the performance of trainees and provided feedback. Results: At baseline, the degree of trainees ’ agreement with the self-efficacy-related statements, including the aspects of familiarity, confidence , and anxiety about tracheostomy-related knowledge and care skills, were not different between the control and intervention groups. At follow-up stage, compared with the regular group, a higher percentage of intervention group ’ trainees reported that they are “strongly agree” or “somewhat agree” that the HMD-VR simulation increases their self-efficacy, including the aspects of familiarity and confidence , and reduced their anxiety about tracheostomy-related knowledge and care skills. After implementation, a higher degree of trainees ’ average satisfaction with VR-based training and VR materials was observed in the intervention group than in the regular group. Most reported that VR materials enabled accurate messaging and decreased anxiety. The increasing trend of the average written test and hands-on tracheostomy care skills scores among the intervention group trainees was significant compared to those in the regular group. The benefits of HMD-VR simulations and web-VR material-based clinical services for in-hospital healthcare providers and patient families p...

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“…AHLE is still a rare and fulminant disease with a mostly life-threatening outcome and a high mortality. The disease mostly affects young males but is also reported in patients of all ages ( 16 ). Even with early aggressive immunosuppressive treatment, AHLE can be a devastating condition in terms of mortality and severe neurological sequelae.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Minimal Neurological Deficit of Two Adult Patients With Weston–Hurst Syndrome Due to Early Craniectomy: Case Series and Review of Literature on Craniectomy

et al. 2021

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Objectives: We describe two new cases of acute hemorrhagic leucoencephalitis (AHLE), who survived with minimal sequelae due to early measures against increased intracranial pressure, particularly craniotomy. The recently published literature review on treatment and outcome of AHLE was further examined for the effect of craniotomy.Methods: We present two cases from our institution. The outcome of 44 cases from the literature was defined either as good (no deficit, minimal deficit/no daily help) or poor outcome (severe deficit/disabled, death). Patients with purely infratentorial lesions (n = 9) were excluded. Fisher's exact test was applied.Results: Two cases are presented: A 43-year-old woman with rapidly progressive aphasia and right hemiparesis due to a huge left frontal white matter lesion with rim contrast enhancement. Pathology was consistent with AHLE. The second case was a 56-year-old woman with rapidly progressive aphasia and right hemiparesis. Cranial MRI showed a huge left temporo-occipital white matter lesion with typical morphology for AHLE. Both patients received craniotomy within the first 24 h and consequent immunosuppressive-immunomodulatory treatment and survived with minimal deficits. Out of 35 supratentorial reported AHLE cases, seven patients received decompressive craniotomy. Comparing all supratentorial cases, patients who received craniotomy were more likely to have a good outcome (71 vs. 29%).Conclusion: Due to early control of the intracranial pressure, particularly due to early craniotomy; diagnosis per biopsy; and immediate start of immunosuppressive-immunomodulatory therapies (cortisone pulse, plasma exchanges), both patients survived with minimal sequelae. Craniotomy plays an important role and should be considered early on in patients with probable AHLE.

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Acute Haemorrhagic Leucoencephalitis Complicating Sepsis

Abstract: A case of acute haemorrhagic leucoencephalitis presenting as fatal septic encephalopathy is reported. The clinical features of this condition are reviewed and the potential for earlier diagnosis is considered.

Cited by 6 publications

References 10 publications

Acute Disseminated Encephalomyelitis in North Indian Children: Clinical Profile and Follow-Up

Acute Disseminated Encephalomyelitis in North Indian Children: Clinical Profile and Follow-Up

Immersive virtual reality (VR) training increases the self-efficacy of in-hospital healthcare providers and patient families regarding tracheostomy-related knowledge and care skills

Case Report: Minimal Neurological Deficit of Two Adult Patients With Weston–Hurst Syndrome Due to Early Craniectomy: Case Series and Review of Literature on Craniectomy

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