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Leucoencefalopatía hemorrágica aguda. Reporte de caso / Acute hemorrhagic leukoencephalopathy. Case report

Crhistian Alejandro Aguilar-Vázquez, Alejandra Diana Raymundo-Carrillo, Nallely Denisse Ruvalcaba-Sánchez, Daniela Alexia Castillo-León, Erick Francisco Gutiérrez-Guzmán

Resumen


 

Resumen

Introducción: la leucoencefalitis hemorrágica aguda (AHLE, por sus siglas en inglés) es una enfermedad inflamatoria del cerebro que conduce a una desmielinización hemorrágica del sistema nervioso central (SNC), de mal pronóstico y alta mortalidad. Muchas veces se asocia a diferentes patógenos que provocan un mimetismo molecular.

Caso clínico: presentamos el caso de una paciente mexicana, que presentó una clínica de una evolución aguda de tipo multifocal. Inicialmente asociado a un cuadro de origen infeccioso, aparentemente viral. Posterior a ese cuadro la paciente presenta una evolución tórpida, con retraso del diagnóstico. Acude con las manifestaciones clínicas, radiológicas y en líquido cefalorraquídeo compatibles con la enfermedad, aunque se da tratamiento inmunosupresor de manera energética la paciente presenta poca respuesta al tratamiento, con muchas secuelas por la enfermedad.

Conclusión: existe poca evidencia sobre la evolución clínica y el manejo médico de la enfermedad y se necesitan más estudios para caracterizarla mejor y brindar más información sobre su pronóstico y manejo. En este artículo se provee una revisión sistemática de la bibliografía.

 

Abstract

Background: Acute hemorrhagic leukoencephalitis (AHLE) is an inflammatory disease of the brain, with a fulminant course that leads to a hemorrhagic demyelination of the central nervous system, having a poor prognosis and high mortality. Most of the times associated to crossed reactivity and molecular mimicry.

Clinical case: We present a case report of a previously healthy young woman with an acute and multifocal clinical course, preceded by a viral respiratory tract infection, followed by a rapid disease progression and a delay in the diagnosis. The clinical, neuroimaging and cerebrospinal fluid featured suggested the diagnosis of AHLE, despite efforts and management with immunosuppression and intensive care, the response to treatment was poor leaving the patient with a severe neurological impairment.

Conclusion: There is little evidence regarding the clinical course and treatment of this disease, and more studies are needed to better characterize it and to provide further information about its prognosis and management. This paper gives a systematic review of the literature.


Palabras clave


Leucoencefalitis Hemorrágica Aguda; Enfermedades Desmielinizantes; Sistema Nervioso Central / Leukoencephalitis, Acute Hemorrhagic; Demyelinating Diseases; Central Nervous System

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Referencias


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