Magnetic resonance imaging spectrum of acute hemorrhagic leukoencephalitis: Four case reports

Table 1 Blood investigation, cerebrospinal fluid analysis and magnetic resonance imaging findings of patients

Investigation	Patient 1	Patient 2	Patient 3	Patient 4
Complete blood count	Hb-9.0 gm, Leukocytosis with neutrophilia	Hb-12 gm, Leukocytosis	Hb-13.2 gm, Leukocytosis with neutrophilia	Hb-12 gm, Leukocytosis with neutrophilia
C-reactive protein	Elevated (14.43 mg/L)	Elevated (19.67 mg/L)	Elevated (15.24 mg/L)	Elevated (13.73 mg/L)
Erythrocyte sedimentation rate	Elevated (47 mm/hour)	Elevated (56 mm/hour)	Elevated (52 mm/hour)	Elevated (45 mm/hour)
Liver function test	Raised AST, ALT. Normal ALP and bilirubin	Raised AST, ALT. Normal ALP and bilirubin	Raised AST, ALT, ALP and bilirubin (1.1 mg/dL)	Normal AST, ALT and bilirubin level
Renal function test	Normal	Normal	Normal	Normal
Viral markers	Negative	Negative	Negative	Negative
Cerebrospinal fluid analysis	Elevated protein levels, neutrophilic pleocytosis, elevated glucose, no organism detected, normal ADA levels (8.2 U/L)	Decreased glucose level, increased. Proteins and neutrophilic pleocytosis. Normal ADA levels (9.7 U/L). No organism detected on Gram stain	Elevated protein, normal glucose. Neutrophilic pleocytosis. Normal ADA level (7.6 U/L)	Elevated protein, normal glucose. Neutrophilic pleocytosis. Normal ADA level (5.6 U/L)
Autoimmune markers	Negative	NA	Negative	Negative
Blood culture	Negative	Negative	NA	Negative
MRI brain	Multiple flocculent predominant white matter hyperintensties on T2/FLAIR weighted images with internal micro and macrohemorrhages. Corpus callosum, brainstem, capsular region, hypothalamus also involved	Multiple hyperintense areas were seen on T2/FLAIR images involving subcortical/deep white matter of the bilateral cerebral hemisphere with internal hemorrhagic changes with involvement of hypothalamus, brainstem, cerebellum and scanned spinal cord	Multiple white matter hyperintensties on T2/FLAIR weighted images with involvement of corpus callosum, capsular region and brainstem. Internal hemorrhagic foci were detected in few lesions	Multifocal white matter hyperintensities both in subcortical/deep white matter on T2/FLAIR weighted images with internal hemorrhagic areas

Hb: Hemoglobin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; ADA: Adenosine deaminase; FLAIR: Fluid attenuated inversion recovery.