Acute leukoencephalopathy with restricted diffusion

Kamate, Mahesh

doi:10.4103/ijccm.ijccm_139_18

Cited by 20 publications

(21 citation statements)

References 17 publications

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“…Less likely differential diagnoses for leukoencephalopathy based on history, signalment, bloodwork, and lesion distribution included radiation-associated encephalopathy ( 61 ), cobalamin and copper deficiency ( 62 ), hypotensive periventricular leukoencephalopathy (PVL) ( 63 , 64 ), age-associated periventricular lesions (”leukoaraiosis“) ( 65 ), and leukocentric presentations of infectious or immune-mediated diseases, such as distemper ( 66 ), parvovirus ( 67 ), and granulomatous meningoencephalomyelitis ( 68 ). Progressive multifocal leukoencephalopathy associated with John Cunningham (JC) virus, ( 69 ), diffuse leukoencephalopathy associated with COVID-19 ( 70 ), and acute leukoencephalopathy with restricted diffusion associated with bacterial/viral infections are reported in humans ( 71 ), but not dogs. Hypoglycemia can predominantly affect white matter in humans ( 72 ), although gray matter involvement is common and such lesions may also predominate in CO exposure depending on exposure timing ( 49 , 73 , 74 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs

et al. 2022

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Bromethalin toxicosis is an increasingly common clinical presentation in dogs that may be fatal depending on the extent of intoxication. Antemortem diagnosis of bromethalin toxicosis was achieved in three dogs by demonstration of the active metabolite desmethylbromethalin in fat or serum. Magnetic resonance imaging (MRI) findings were consistent with a diffuse leukoencephalopathy with restricted diffusion and prominent involvement of the corticospinal motor tracts on T2-weighted and diffusion-weighted sequences. Imaging findings were confirmed in one non-surviving dog at necropsy. Resolution of MRI abnormalities was demonstrated in one surviving dog that was consistent with the associated resolution of clinical signs. Initial findings in these dogs support further investigation of specific MRI patterns in cases of leukoencephalopathy to aid differential diagnosis. While antemortem detection of bromethalin and its metabolites confirms exposure, quantitation may be informative as a prognostic biomarker.

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Section: Discussionmentioning

confidence: 99%

Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs

et al. 2022

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“…Follow-up imaging maybe normal with resolution of white matter restriction on DWI over 2–4 weeks. ADEM is a close differential with multifocal restriction more pronounced in T2 weighted (T2W) images than DWI unlike in ALERD [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Leukoencephalopathy with Restricted Diffusion in an Infant with Severe COVID-19 and Dengue Coinfection Progressing to West Syndrome

Kariyappa

Govindarajan

Kommalur

2021

Journal of Tropical Pediatrics

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COVID-19 pandemic is increasingly being recognized in infants and some develop cytokine storm mediated tissue damage. We report 5-month-old infant presenting with fever, refusal of feeds, developing altered sensorium and convulsions during the hospital course, tested positive for SARS-CoV2 RT-PCR in second week of illness. Her serology was also Dengue positive. She had features of cytokine storm and her MRI Brain suggested acute demyelinating encephalomyelitis (ADEM). She was treated with high-dose methylprednisolone followed oral prednisolone, under antibiotics cover. Infant improved gradually over 3 weeks duration following a stormy hospital course. On follow-up, infant showed delayed motor milestones with epileptic spasms and hysparrhthymia on EEG, progressing to develop secondary West syndrome. Features of acute encephalopathy, hypercytokinemia and restricted diffusion on DWI–MRI, with post-encephalopathic epilepsy, pointed to a differential of ADEM—acute leukoencephalopathy with restricted diffusion (ALERD) as the primary diagnosis; establishing ALERD as a possible neurological complication of COVID-19 infection in infants. Timeline of events. There is a demonstrable fall in the inflammatory markers with clinical improvement following the start of intravenous methylprednisolone. Epileptic spasms and developmental delay with hypsarrhthymia noted on follow-up, suggestive of secondary West syndrome.

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“…18 The presence of elevated Glx levels has been reported in cases of acute excitotoxic leukoencephalopathy 19 and viral-associated acute leukoencephalopathy with restricted diffusion. 20 Both conditions are thought to be mediated by excitotoxic injury to the cerebral white matter and exhibit prominent reduced diffusivity within white matter lesions.…”

Section: Discussionmentioning

confidence: 99%

Brain MR Spectroscopic Findings in 3 Consecutive Patients with COVID-19: Preliminary Observations

Rapalino¹,

Weerasekera

Moum

et al. 2020

AJNR Am J Neuroradiol

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Brain multivoxel MR spectroscopic imaging was performed in 3 consecutive patients with coronavirus disease 2019 . These included 1 patient with COVID-19-associated necrotizing leukoencephalopathy, another patient who had a recent pulseless electrical activity cardiac arrest with subtle white matter changes, and a patient without frank encephalopathy or a recent severe hypoxic episode. The MR spectroscopic imaging findings were compared with those of 2 patients with white matter pathology not related to Severe Acute Respiratory Syndrome coronavirus 2 infection and a healthy control subject. The NAA reduction, choline elevation, and glutamate/glutamine elevation found in the patient with COVID-19-associated necrotizing leukoencephalopathy and, to a lesser degree, the patient with COVID-19 postcardiac arrest, follow a similar pattern as seen with the patient with delayed posthypoxic leukoencephalopathy. Lactate elevation was most pronounced in the patient with COVID-19 necrotizing leukoencephalopathy.

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Acute leukoencephalopathy with restricted diffusion

Cited by 20 publications

References 17 publications

Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs

Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs

Acute Leukoencephalopathy with Restricted Diffusion in an Infant with Severe COVID-19 and Dengue Coinfection Progressing to West Syndrome

Brain MR Spectroscopic Findings in 3 Consecutive Patients with COVID-19: Preliminary Observations

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