{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T04:04:39Z","timestamp":1792555479322,"version":"4.5.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:p>This report highlights an atypical case of acute hemorrhagic Leukoencephalitis (AHLE) in a 73-year-old male, contributing valuable insights into the disease\u2019s progression in older adults. AHLE, a rare and often fatal central nervous system disorder typically affecting younger individuals, with a median age of 33. Our patient experienced atypical subacute symptoms over 3 months, the longest duration reported, and ultimately achieved a functional outcome with a modified Rankin Scale (mRS) score of 2. A comprehensive review of 152 cases available through PubMed, revealing a 58% mortality rate with a median survival of just 2 days, and a mean mRS of 4.3, though survivor exhibited a more favorable mean mRS of 1.8. Only 6% of cases had a subacute onset of 3 weeks or more.<\/jats:p>","DOI":"10.3389\/fnins.2025.1557046","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T05:54:27Z","timestamp":1743400467000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Acute hemorrhagic leukoencephalitis with gradual symptom onset: Case Report and literature review"],"prefix":"10.3389","volume":"19","author":[{"given":"Ida","family":"Sannes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne E.","family":"Harr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen-Ann","family":"Antal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona K.","family":"Beyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaja","family":"Nordengen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"6008375","DOI":"10.1155\/2022\/6008375","article-title":"Acute hemorrhagic Leukoencephalitis (AHLE): a comprehensive review on causes, symptoms, link with COVID-19, diagnosis, and treatment","volume":"2022","author":"Alromaihi","year":"2022","journal-title":"Biomed. Res. Int."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e935636","DOI":"10.12659\/AJCR.935636","article-title":"Acute hemorrhagic Leukoencephalitis - a rare but fatal form of acute disseminated encephalomyelitis - complicated by brain herniation: a case report and literature review","volume":"23","author":"Alsaid","year":"2022","journal-title":"Am J Case Rep."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.clineuro.2016.02.014","article-title":"Acute disseminated encephalomyelitis presenting as a brainstem encephalitis","volume":"143","author":"Atherton","year":"2016","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3741","DOI":"10.1007\/s10072-023-06847-0","article-title":"Acute hemorrhagic leukoencephalitis as a new phenotype of myelin oligodendrocyte glycoprotein antibody-associated disease","volume":"44","author":"Bang","year":"2023","journal-title":"Neurol. Sci."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/BF02043226","article-title":"Acute hemorrhagic leukoencephalopathy: clinical and CT diagnosis and histopathological confirmation in an elderly patient","volume":"5","author":"Barontini","year":"1984","journal-title":"Ital. J. Neurol. Sci."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/j.clineuro.2010.06.017","article-title":"Hemorrhagic leukoencephalitis linked to Epstein-Barr virus in an adult patient","volume":"112","author":"Befort","year":"2010","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.clineuro.2018.08.007","article-title":"Weston-Hurst syndrome with acute hemorrhagic cerebellitis","volume":"173","author":"Bonduelle","year":"2018","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s10072-008-0003-9","article-title":"Acute hemorrhagic leukoencephalitis with atypical features","volume":"30","author":"Catalan","year":"2009","journal-title":"Neurol. Sci."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1017\/S031716710001636X","article-title":"Autopsy-proven acute hemorrhagic Leukoencephalitis in an elderly patient","volume":"41","author":"Chakraborty","year":"2014","journal-title":"Canad. J. Neurol. Sci."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1007\/s00415-010-5772-4","article-title":"Acute hemorrhagic leukoencephalopathy associated with influenza a (H1N1) virus","volume":"258","author":"Cisse","year":"2011","journal-title":"J. Neurol."},{"key":"ref11","first-page":"19","article-title":"Acute hemorrhagic leukoencephalitis associated with autoimmune myopathy","volume":"7","author":"Duggal","year":"2014","journal-title":"J. Vasc. Interv. Neurol."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.1007\/s13760-022-02108-7","article-title":"Acute hemorrhagic leukoencephalitis in an adult: prominent response with cyclophosphamide","volume":"123","author":"Garcia-Castellon","year":"2023","journal-title":"Acta Neurol. Belg."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"19","DOI":"10.3109\/01913129409016269","article-title":"Tubular inclusions in macrophages in the brain of a patient with acute hemorrhagic leukoencephalitis (Weston-Hurst syndrome)","volume":"18","author":"Gillies","year":"1994","journal-title":"Ultrastruct. Pathol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1016\/j.clinph.2019.03.014","article-title":"Do not rely on imaging to predict awakening: the value of neurophysiology in a case of Weston-Hurst syndrome","volume":"130","author":"Gobert","year":"2019","journal-title":"Clin. Neurophysiol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1136\/jnnp.42.1.19","article-title":"Brain damage complicating septic shock: acute haemorrhagic leucoencephalitis as a complication of the generalised Shwartzman reaction","volume":"42","author":"Graham","year":"1979","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"899","DOI":"10.3389\/fneur.2020.00899","article-title":"Acute hemorrhagic Leukoencephalitis: a case and systematic review of the literature","volume":"11","author":"Grzonka","year":"2020","journal-title":"Front. Neurol."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1177\/08830738040190010709","article-title":"Acute necrotizing encephalopathy of childhood associated with influenza type B virus infection in a 3-year-old girl","volume":"19","author":"Huang","year":"2004","journal-title":"J. Child Neurol."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5694\/j.1326-5377.1941.tb46531.x","article-title":"Acute h\u00e6morrhagic leucoencephalitis: a previously undefined entity","volume":"2","author":"Hurst","year":"1941","journal-title":"Med. J. Aust."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e25545","DOI":"10.1016\/j.heliyon.2024.e25545","article-title":"Acute hemorrhagic leukoencephalitis following the first dose of BNT162b2 vaccine against SARS-CoV-2: a case report","volume":"10","author":"Kalafatakis","year":"2024","journal-title":"Heliyon"},{"key":"ref20","first-page":"245","article-title":"Acute hemorrhagic Leukoencephalitis in children: a case report","volume":"41","author":"Khademi","year":"2016","journal-title":"Iran J Med Sci."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1212\/01.WNL.0000048493.82053.4C","article-title":"Acute hemorrhagic leukoencephalitis vs ADEM: FLAIR MRI and neuropathology findings","volume":"60","author":"Kuperan","year":"2003","journal-title":"Neurology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1097\/PAF.0b013e3181c6be92","article-title":"Acute hemorrhagic Leukoencephalitis: a critical Entity for forensic pathologists to recognize","volume":"31","author":"Lann","year":"2010","journal-title":"Am J Forensic Med Pathol"},{"key":"ref23","first-page":"1996","article-title":"Serial MR imaging findings of acute hemorrhagic leukoencephalitis: a case report","volume":"26","author":"Lee","year":"2005","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"673611","DOI":"10.3389\/fneur.2021.673611","article-title":"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","volume":"12","author":"Loesch-Biffar","year":"2021","journal-title":"Front. Neurol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1136\/jnnp.56.8.920","article-title":"Acute disseminated encephalomyelitis presenting as a solitary brainstem mass","volume":"56","author":"Miller","year":"1993","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/j.1440-1819.1986.tb01617.x","article-title":"An autopsied case of acute hemorrhagic leukoencephalitis","volume":"40","author":"Mitsuyama","year":"1986","journal-title":"Jpn. J. Psychiatry Neurol."},{"key":"ref27","first-page":"270","article-title":"Acute hemorrhagic leukoencephalitis in patients with acute myeloid leukemia in hematologic complete remission","volume":"84","author":"Pagano","year":"1999","journal-title":"Haematologica"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1002\/jmri.22505","article-title":"Acute hemorrhagic leukoencephalitis with severe brainstem and spinal cord involvement: MRI features with neuropathological confirmation","volume":"33","author":"Pinto","year":"2011","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1097\/PAF.0000000000000642","article-title":"A case series of acute hemorrhagic Leukoencephalitis","volume":"42","author":"Podduturi","year":"2021","journal-title":"Am J Forensic Med Pathol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1111\/j.1537-2995.2007.01227.x","article-title":"Use of therapeutic plasma exchange in the management of acute hemorrhagic leukoencephalitis: a case report and review of the literature","volume":"47","author":"Ryan","year":"2007","journal-title":"Transfusion"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"592","DOI":"10.21037\/qims.2017.06.09","article-title":"Diffuse glioblastoma resembling acute hemorrhagic leukoencephalitis","volume":"7","author":"Schettino","year":"2017","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1007\/s13760-017-0861-0","article-title":"Acute hemorrhagic leukoencephalitis after seasonal influenza vaccination","volume":"118","author":"Sinzobahamvya","year":"2018","journal-title":"Acta Neurol. Belg."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/BF00341253","article-title":"Computed tomography in acute haemorrhagic leukoencephalitis","volume":"22","author":"Valentine","year":"1982","journal-title":"Neuroradiology"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1007\/s00234-021-02667-1","article-title":"Acute hemorrhagic leukoencephalitis in a COVID-19 patient-a case report with literature review","volume":"63","author":"Varadan","year":"2021","journal-title":"Neuroradiology"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e106","DOI":"10.1212\/WNL.0b013e31821d748a","article-title":"Clinical reasoning: a young adult presents with focal weakness and hemorrhagic brain lesions","volume":"76","author":"Virmani","year":"2011","journal-title":"Neurology"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1002\/jdn.10201","article-title":"Clinical features and imaging manifestations of acute necrotizing encephalopathy in children","volume":"82","author":"Wu","year":"2022","journal-title":"Int. J. Dev. Neurosci."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"301","DOI":"10.2169\/internalmedicine.4405-24","article-title":"Acute hemorrhagic Leukoencephalitis with concurrent retinal Vasculitis in an elderly Japanese patient: a case report","volume":"64","author":"Yamaguchi","year":"2024","journal-title":"Intern. Med."}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2025.1557046\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T13:04:34Z","timestamp":1745327074000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2025.1557046\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,31]]},"references-count":37,"alternative-id":["10.3389\/fnins.2025.1557046"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2025.1557046","relation":{},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,31]]},"article-number":"1557046"}}