Acute Leukoencephalopathy with Diffusion Restriction in a pre-school child – A Case Report

Abstract

Background: Acute leukoencephalopathy with restricted diffusion (ALERD) is a clinical-radiological diagnosis characterized by severe encephalopathy and seizures with restricted diffusion in the bilateral cerebral parenchyma on Magnetic Resonance Imaging.

Clinical description: A 1-year-6-month-old female child admitted with complaints of fever and loose motion for 3 days, followed by repeated episodes of generalized tonic-clonic seizure. On examination, the child was unconscious and afebrile, GCS -12/15. Planter B/L non-responding, deep tendon reflex was brisk. Other systemic examinations were within normal limits.

Management & outcome: Complete blood count showed the presence of leukocytosis with neutrophilic predominance. In cerebrospinal fluid examination, 10-12 cells are predominantly lymphocytic. Other biochemical parameters are within normal limits.  MRI brain showed diffusion restriction of bilateral cortical and subcortical frontal, parietal, and temporal regions, along with corpus callosum and ventral thalami, suggestive of diffused ALERD. The patient was treated with intravenous methyl prednisolone 30 mg/kg, which was given for 3 days, followed by oral prednisolone along with symptomatic treatment.

Conclusion: This case highlights the importance of early recognition of ALERD, and proper immunotherapy, which provides better outcomes. 

Keywords: Febrile encephalopathy, Immunotherapy, Leukoencephalopathy, Magnetic resonance induction, Seizure