The spectrum of acute leukoencephalopathy with restricted diffusion (ALERD): A case series and review of literature

Lawrence, Rose Mary; Aripirala, Prasanthi; Reddy, Nihaal; Rizwan, Akheel; B, Satyanarayana Reddy; Poddutoor, Preetham; Jain, Romit; Kundana, P Keerthi; Lingappa, Lokesh; Konanki, Ramesh

doi:10.1016/j.ejpn.2021.05.017

Cited by 11 publications

(4 citation statements)

References 9 publications

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“…4 A case series from an Indian population by Lawrence et al identified dengue hemorrhagic fever as the primary cause. 5 In our case, the respiratory panel test was positive for influenza B virus. Therefore, the likely etiology of our patient's condition was a viral infection caused by influenza B virus.…”

Section: Discussionmentioning

confidence: 51%

Be Alert to ALERD: Acute Leukoencephalopathy with Restricted Diffusion—Atypical Presentation of a Rare Case

Baby,

Ajith,

Mohammed

et al. 2024

Journal of Pediatric Neurology

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Acute leukoencephalopathy with restricted diffusion (ALERD) is a novel entity observed in children with acute encephalopathy. It is characterized by diffusion restriction on magnetic resonance imaging (MRI), which can be the distinctive and sometimes the only imaging finding. Other routine MRI sequences may appear normal. ALERD can have infectious or noninfectious causes. In this case, we present a patient with infectious ALERD associated with influenza B virus. A 10-year-old boy presented to the emergency room with a brief history of fever and cough, followed by altered sensorium. He was irritable and ataxic. Neck stiffness was elicited upon examination. An MRI of the brain showed extensive symmetric diffusion restriction in the periventricular and deep white matter, corpus callosum, posterior limb of the internal capsule, and cerebral peduncles of both cerebral hemispheres. Cerebrospinal fluid study, blood and urine toxicology panels were noncontributory. The respiratory panel test was positive for influenza B. A diagnosis of infectious ALERD was made. Following treatment with steroids, intravenous immunoglobulin, antiglutamate agents, and supportive measures, he showed clinical and radiological improvement. The reporting of ALERD has risen in recent years due to its increased detection using MRI. Diffusion-weighted image plays the key role in the final diagnosis. Supportive care and prompt treatment of seizures are very important for better outcome. Follow-up imaging is also required to assess reappearance of white matter edema and development of cerebral atrophy or gliosis.

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Section: Discussionmentioning

confidence: 51%

Be Alert to ALERD: Acute Leukoencephalopathy with Restricted Diffusion—Atypical Presentation of a Rare Case

Baby,

Ajith,

Mohammed

et al. 2024

Journal of Pediatric Neurology

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“…[ 5 ]. In a study by Lawrence et al, dengue hemorrhagic fever was the most common cause of ALERD [ 6 ]. Ischemia and brain infarction can also result in a similar picture [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since in most cases, there are residual neurological issues such as cognitive impairment or delay [ 6 ] and speech problems [ 14 ], evaluation of all cases of ALERD is of vital importance. Matsuo et al, in their study, evaluated dextromethorphan and cyclosporine A for ALERD cases and found them to be effective in most patients [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…The term acute leukoencephalopathy with restricted diffusion (ALERD) is used for children presenting with seizures, encephalopathy symptoms, and restricted diffusion on MRI at presentation itself. It can be because of various infections and does not have a biphasic clinical picture [ 6 ]. Long-term neurological sequelae can be observed in patients presenting with ALERD.…”

Section: Introductionmentioning

confidence: 99%

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Atypical Presentation Resembling Acute Leukoencephalopathy With Restricted Diffusion in Staphylococcus aureus Meningoencephalitis

Ranjan,

Wander,

Kaur

et al. 2024

Cureus

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Meningoencephalitis refers to inflammation of the brain and meninges. It can be caused by various organisms, such as Neisseria meningitidis , Streptococcus pneumoniae , and so on. Staphylococcus aureus causing meningoencephalitis is relatively rare. It is mainly encountered in patients who have undergone surgeries in the past. Acute leukoencephalopathy with restricted diffusion (ALERD) is a type of encephalopathy that can involve both white and grey matter of the brain, and it has a characteristic “bright tree appearance” on MRI. It can be because of various infectious etiologies or caused by various toxins. Neurological sequelae are observed in about two out of three cases. Here, we describe a case of S. aureus meningoencephalitis with ALERD, which has been seldom reported. More awareness about this is required among primary care physicians for timely diagnosis and management to prevent any complications.

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Severe Plasmodium vivax Malaria Complicated with Acute Leukoencephalopathy with Restricted Diffusion

Manjunathan,

Anisha,

Bhatia

et al. 2024

Indian J Pediatr

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The spectrum of acute leukoencephalopathy with restricted diffusion (ALERD): A case series and review of literature

Cited by 11 publications

References 9 publications

Be Alert to ALERD: Acute Leukoencephalopathy with Restricted Diffusion—Atypical Presentation of a Rare Case

Be Alert to ALERD: Acute Leukoencephalopathy with Restricted Diffusion—Atypical Presentation of a Rare Case

Atypical Presentation Resembling Acute Leukoencephalopathy With Restricted Diffusion in Staphylococcus aureus Meningoencephalitis

Severe Plasmodium vivax Malaria Complicated with Acute Leukoencephalopathy with Restricted Diffusion

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